Provider Demographics
NPI:1053024844
Name:SULLIVAN, THERESA M (WHNP-BC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:DOMBROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2706 S WOLFF ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-2009
Mailing Address - Country:US
Mailing Address - Phone:740-275-7467
Mailing Address - Fax:
Practice Address - Street 1:2706 S WOLFF ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-2009
Practice Address - Country:US
Practice Address - Phone:740-275-7467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998292-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health