Provider Demographics
NPI:1699965392
Name:SULLIVAN, SHARON A (RNC-OB, IBCLC)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RNC-OB, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17307 SNEE OOSH RD
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-9112
Mailing Address - Country:US
Mailing Address - Phone:907-738-4507
Mailing Address - Fax:
Practice Address - Street 1:17307 SNEE OOSH RD
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-9112
Practice Address - Country:US
Practice Address - Phone:907-738-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-29
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60926340163W00000X
IL104338339163WX0003X
VA11169652163WL0100X
AK26022163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60926340OtherRN LICENSE
VA11169652OtherIBCLC - INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT
AK26022OtherRN LICENSE