Provider Demographics
NPI:1730205899
Name:SULLIVAN, ROSEMARY (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:MISS
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PEACH SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:86434-0190
Mailing Address - Country:US
Mailing Address - Phone:928-769-2900
Mailing Address - Fax:928-769-2701
Practice Address - Street 1:943 HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:PEACH SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86434-0190
Practice Address - Country:US
Practice Address - Phone:928-769-2900
Practice Address - Fax:928-769-2701
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN051754163WA2000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care