Provider Demographics
NPI:1487418729
Name:SULLENDER, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SULLENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E HEFRON ST STE 150
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-2790
Mailing Address - Country:US
Mailing Address - Phone:812-254-8666
Mailing Address - Fax:812-254-8643
Practice Address - Street 1:300 E HEFRON ST STE 150
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2790
Practice Address - Country:US
Practice Address - Phone:812-254-8666
Practice Address - Fax:812-254-8643
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28112338A163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health