HEATHER SULLIVAN FNP NPI 1205383890

NPI Information

NPI: 1205383890
Provider Name: HEATHER SULLIVAN, FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: NORTH BEND MEDICAL CENTER INC

PECOS Registration: Yes

Address:
110 10TH ST SE
BANDON, OR
ZIP 97411
Phone: (541) 347-2313
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Heather Sullivan, FNP is a family nurse practitioner in Bandon, OR with 8 years of experience. Heather Sullivan, FNP NPI is 1205383890. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

110 10TH ST SE
BANDON, OR
ZIP 97411-157
Phone: (541) 347-2313
Fax: (541) 347-2015

The NPI 1205383890 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/1/2016 and was last updated on 9/19/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		200341475RN	OREGON	No
2	363LF0000X	Nurse Practitioner	Family	117094	ALASKA	No
3	363LF0000X	Nurse Practitioner	Family	201607221NP-PP	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500766156	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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