Laverne A Sullivan, RD
Dietitian, Registered in Fort Wayne, IN. Individual provider (NPI-1).
NPI number1023045200
StatusActive
Last updated in NPPESJul 1, 2014
Details
- NPI
- 1023045200
- Entity type
- Individual (NPI-1)
- Name
- Laverne A Sullivan
- Credential
- RD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 26, 2006
- Last updated
- Jul 1, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | 37000748A | IN | Yes |
Practice location
4210 Flagstaff CvFort Wayne, IN 46815-4417
Phone 260-489-9009 · Fax 260-489-5057
Mailing address
5244 Jeffries LaneNewburgh, IN 47630
Phone 812-454-1710 · Fax 260-489-5057
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