Provider Demographics
NPI:1285735829
Name:SULLIVAN, VIKI CATHERINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:VIKI
Middle Name:CATHERINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2575 E BIDWELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6444
Practice Address - Country:US
Practice Address - Phone:916-817-3700
Practice Address - Fax:916-817-3701
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN516187-12968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily