| Doctor Name: | MARICEL M SULLIVAN |
| NPI Number: | 1255621314 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 041342275 |
| Business Practice Address: | 1473 Ring Rd Calumet City, IL - 604095459 |
| Business Phone Number: | 7088628156 |
| Business Fax Number: | |
| Mailing Address: | 9730 S Cicero Ave, OAK LAWN |
| State: | IL |
| Postal Code: | 604533174 |
| Phone Number: | 7086554146 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2011 |
| NPI Last Update Date: | 04/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 041342275 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |