Doctor Name: | JACQUELINE MARY SULLIVAN |
NPI Number: | 1740511104 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 685422 |
Business Practice Address: | W3985 County Road Nn Elkhorn, WI - 531214337 |
Business Phone Number: | 2627412145 |
Business Fax Number: | 2627412559 |
Mailing Address: | 600 Highland Ave, Compliance Mc 2433 MADISON |
State: | WI |
Postal Code: | 537920001 |
Phone Number: | 6086620817 |
Fax Number: | 6082034544 |
NPI Enumeration Date: | 01/26/2010 |
NPI Last Update Date: | 10/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 685422 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |