Laverne A Sullivan RD

NPI 1023045200 - Dietitian, Registered - 133V00000X

NPI Details
NPI 1023045200
Gender Female
Enumeration Date 06/26/2006
Last Updated 07/01/2014
Entity Type Individual
Active Over 10 years ago
Practice Location
4210 FLAGSTAFF CV
FORT WAYNE IN, 46815-4417, US
Phone (260) 489-9009
Fax (260) 489-5057
Business Location
5244 JEFFRIES LANE
NEWBURGH IN, 47630, US
Phone (812) 454-1710
Fax (260) 489-5057
Toxanomy
Taxonomy Code 133V00000X
License State Indiana
License Number 37000748A
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According to our database, Laverne A Sullivan RD NPI is 1023045200, taxonomy code is 133V00000X and license number is 37000748A, license state is located at Indiana. Laverne A Sullivan RD physically located at 4210 Flagstaff Cv, Fort Wayne IN, 46815-4417. NPI Number Laverne A Sullivan RD has the Individual type.

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1023045200 NPI number is provided on an as is basis without warranty of any kind. 1023045200 is maintained by the National Plan & Provider Enumeration System. The contents of Laverne A Sullivan RD are for informational purposes only.