Active NPI
Michele L Sullivan, LMT
- Case Manager/Care Coordinator
- Canby, OR
National Provider Identifier
1710218003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 17056
- Practice address
- 7216 S Seven Oaks LN
Canby, OR 97013-9531 - Phone
- (503) 680-2497
- NPI assigned
- Jan 26, 2010
- Last updated
- Jan 26, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 17056 | OR | Primary |
Addresses
Primary practice location
7216 S Seven Oaks LN
Canby, OR 97013-9531
Mailing address
7216 S Seven Oaks LN
Canby, OR 97013-9531
Phone (503) 680-2497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17056 | OR | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264464000000",
"number": "1710218003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7216 S SEVEN OAKS LN",
"city": "CANBY",
"state": "OR",
"postal_code": "970139531",
"telephone_number": "503-680-2497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7216 S SEVEN OAKS LN",
"city": "CANBY",
"state": "OR",
"postal_code": "970139531",
"telephone_number": "503-680-2497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MICHELE",
"middle_name": "L",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-01-26",
"last_updated": "2010-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OR",
"license": "17056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canby, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.