Provider Demographics
NPI:1962980185
Name:SULLIVAN, ERIN (RDLMNT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RDLMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 O ST STE 7
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1532
Mailing Address - Country:US
Mailing Address - Phone:402-261-5048
Mailing Address - Fax:402-805-4540
Practice Address - Street 1:3100 O ST
Practice Address - Street 2:SUITE 7
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-6851
Practice Address - Country:US
Practice Address - Phone:402-261-5048
Practice Address - Fax:402-805-4540
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered