1750449344 NPI number — DR. MARI CATHERINE SULLIVAN DNP, MSN, ARNP-C

Table of content: DR. MARI CATHERINE SULLIVAN DNP, MSN, ARNP-C (NPI 1750449344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750449344 NPI number — DR. MARI CATHERINE SULLIVAN DNP, MSN, ARNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
MARI
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, MSN, ARNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
MARI
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP, MSN, ARNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750449344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32020 LITTLE BOSTON RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98346-9734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-297-2840
Provider Business Mailing Address Fax Number:
360-925-3897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PORT GAMBLE S'KLALLAM TRIBE COMMUNITY HEALTH
Provider Second Line Business Practice Location Address:
32020 LITTLE BOSTON RD NE
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-297-2840
Provider Business Practice Location Address Fax Number:
360-925-3897
Provider Enumeration Date:
12/05/2006

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:  AP300001946 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: AP30001946 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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