Doctor Name: | MS. KRISPIN N SULLIVAN |
NPI Number: | 1669803805 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CN, RN |
License Number: | |
Business Practice Address: | 938 Wendy Ln Unit B Incline Village, NV - 894519009 |
Business Phone Number: | 7758310292 |
Business Fax Number: | 7759960204 |
Mailing Address: | 938 Wendy Ln, Unit B INCLINE VILLAGE |
State: | NV |
Postal Code: | 894519009 |
Phone Number: | 7758310292 |
Fax Number: | 7759960204 |
NPI Enumeration Date: | 12/12/2013 |
NPI Last Update Date: | 12/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133NN1002X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Nutritionist |
Taxonomy Specialization: | Nutrition, Education |
Taxonomy Definition: |