Provider Demographics
NPI:1285968396
Name:O'SULLIVAN, LOUISE MARY (LAC, RN, LMP)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:MARY
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:LAC, RN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2915
Mailing Address - Country:US
Mailing Address - Phone:206-354-3444
Mailing Address - Fax:
Practice Address - Street 1:5424 BALLARD AVE NW
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4046
Practice Address - Country:US
Practice Address - Phone:206-354-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60083875171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist