Provider Demographics
NPI:1831986744
Name:SULLIVAN, KATIE (MED, CPPD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MED, CPPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3619
Mailing Address - Country:US
Mailing Address - Phone:510-725-2987
Mailing Address - Fax:
Practice Address - Street 1:526 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3619
Practice Address - Country:US
Practice Address - Phone:510-725-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula