Basic Information
| Provider Information | |||||||||
| NPI: | 1962927863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | MAEGAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11059 E BETHANY DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172300 | ||||||||
| FaxNumber: | 3036172365 | ||||||||
| Practice Location | |||||||||
| Address1: | 1646 ELMIRA ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800102122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039236368 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2017 | ||||||||
| LastUpdateDate: | 08/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CO | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.