Provider Demographics
NPI:1376187831
Name:SULLIVAN, HOLLY M
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
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 1:5079 GRENOBLE CT
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5519
Mailing Address - Country:US
Mailing Address - Phone:504-610-3035
Mailing Address - Fax:
Practice Address - Street 1:5079 GRENOBLE CT
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-5519
Practice Address - Country:US
Practice Address - Phone:504-610-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care