1134948599 NPI number — MRS. MALIA M SULLIVAN APRN

Table of content: MRS. MALIA M SULLIVAN APRN (NPI 1134948599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134948599 NPI number — MRS. MALIA M SULLIVAN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
MALIA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134948599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCPHERSON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67460-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-241-2250
Provider Business Mailing Address Fax Number:
620-798-2630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCPHERSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67460-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-641-2251
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  53-83673-101 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com