1568828812 NPI number — MRS. ERIKA SULLIVAN APRN FNP

Table of content: MRS. ERIKA SULLIVAN APRN FNP (NPI 1568828812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568828812 NPI number — MRS. ERIKA SULLIVAN APRN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
ERIKA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568828812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3482
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POST FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83877-3482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-209-6170
Provider Business Mailing Address Fax Number:
208-209-6169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2170 W IRONWOOD CENTER DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-665-5596
Provider Business Practice Location Address Fax Number:
208-665-9842
Provider Enumeration Date:
12/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP-1656A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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