Provider Demographics
NPI:1770144776
Name:SULLIVAN, CAITLIN MICHELLE (NP-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MICHELLE
Last Name:SULLIVAN
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8009 BAMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48761-9741
Mailing Address - Country:US
Mailing Address - Phone:586-596-5435
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704317140363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner