Provider Demographics
NPI:1164262010
Name:SULLIVAN, CONNIE JO
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:JO
Last Name:SULLIVAN
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 1:2 SHEILA CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-5141
Mailing Address - Country:US
Mailing Address - Phone:513-289-8871
Mailing Address - Fax:
Practice Address - Street 1:2 SHEILA CT
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-5141
Practice Address - Country:US
Practice Address - Phone:513-289-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker