Provider Demographics
NPI:1336784628
Name:SULLIVAN, KATIE HALLERAN (NP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:HALLERAN
Last Name:SULLIVAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:HALLERAN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:611 N IRON BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4932
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:
Practice Address - Street 1:1001 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4503
Practice Address - Country:US
Practice Address - Phone:509-444-8200
Practice Address - Fax:509-444-7806
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60997775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner