Provider Demographics
NPI:1073355772
Name:SULLIVAN, MELISSA L (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:GRABAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:848 N SUNRISE BLVD
Mailing Address - Street 2:SUITE 102 BLD A
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282
Mailing Address - Country:US
Mailing Address - Phone:360-629-2524
Mailing Address - Fax:360-610-4979
Practice Address - Street 1:848 N SUNRISE BLVD
Practice Address - Street 2:SUITE 102 BLD A
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282
Practice Address - Country:US
Practice Address - Phone:360-629-2524
Practice Address - Fax:360-610-4979
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60421811163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice