Rebecca J Sullivan

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

205 Issued in NE

Practice address

4117 S 120TH St # 1250
Omaha, NE 68137-1250

Phone

(402) 719-1194

NPI assigned

Nov 2, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1497410690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 WILMONT ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680256214",
            "telephone_number": "402-719-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 S 120TH ST # 1250",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681371250",
            "telephone_number": "402-719-1194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "905 Wilmont St",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "NE",
            "postal_code": "680256214",
            "country_code": "US",
            "telephone_number": "402-719-1194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "REBECCA",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-02",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NE",
            "license": "205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leanne Sullivan
• Monica A. Sullivan, PA-C
• Nevaeh Sullivan
• Nichole Sullivan
• Randall Gene Sullivan, MD
• Robert Sullivan
• Robin Lee Sullivan, LADC, PLMHP
• Sandra N Sullivan
• Sarah F Sullivan, SLP
• Sean Timothy Sullivan, D.D.S.

• Athletic Trainer in Omaha, NE
• Providers in Omaha, NE by specialty
• Athletic Trainer in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.