Kermit C Sullivan III ATC

NPI 1124157185 - Specialist/Technologist - 2255A2300X

NPI Details
NPI 1124157185
Gender Male
Enumeration Date 03/05/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
1303 E GREENHURST RD
NAMPA ID, 83686-7216, US
Phone (208) 468-7820
Fax
Business Location
231 N TURTLE DOVE WAY
NAMPA ID, 83651-8363, US
Phone (208) 442-4354
Fax
Toxanomy
Taxonomy Code 2255A2300X
License State Idaho
License Number AT-182
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According to our database, Mr. Kermit C Sullivan III ATC NPI is 1124157185, taxonomy code is 2255A2300X and license number is AT-182, license state is located at Idaho. Kermit C Sullivan III ATC physically located at 1303 E Greenhurst Rd, Nampa ID, 83686-7216. NPI Number Kermit C Sullivan III ATC has the Individual type.

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1124157185 NPI number is provided on an as is basis without warranty of any kind. 1124157185 is maintained by the National Plan & Provider Enumeration System. The contents of Kermit C Sullivan III ATC are for informational purposes only.