Provider Demographics
NPI:1144905779
Name:SULLIVAN, RHONDA (BSN, RNC-OB, CLC)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BSN, RNC-OB, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 CLIFTON TER
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1000
Mailing Address - Country:US
Mailing Address - Phone:815-509-2511
Mailing Address - Fax:
Practice Address - Street 1:1144 CLIFTON TER
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1000
Practice Address - Country:US
Practice Address - Phone:815-509-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041322177163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health