Sullivan, Mary R.

Sullivan, Mary R. is an individual health care provider with primary practice located at 222 S Herlong Ave , Rock Hill SC 29732-1158. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Sullivan, Mary R. can be contacted via phone (803) 329-6711.

Contact Information

Primary practice address
222 S Herlong Ave Rock Hill SC 29732-1158
Phone: (803) 329-6711
Fax: (803) 329-5120
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 53474 South Carolina

Profile Details

NPI number 1710976246
LBN Legal business name Sullivan, Mary R.
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 18th, 2005
Last updated Oct 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710976246 NPPES
Other A9401 MEDCOST
MEDICAID AN0411 MEDCOST

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