Provider Demographics
NPI:1194989947
Name:SULLIVAN-WHITESIDE, CATHERINE (RN)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:SULLIVAN-WHITESIDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHEAST HEALTH CENTER 5400 EAST 7 MILE ROAD
Mailing Address - Street 2:ROOM 16
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-870-3049
Mailing Address - Fax:313-368-4694
Practice Address - Street 1:NORTHEAST HEALTH CENTER 5400 EAST 7 MILE ROAD
Practice Address - Street 2:ROOM 16
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-870-3049
Practice Address - Fax:313-368-4694
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704176626163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse