Jacqueline Mary Sullivan

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

685422

Practice address

W3985 County Road NN
Elkhorn, WI 53121-4337

Phone

(262) 741-2145

Fax

(262) 741-2559

NPI assigned

Jan 26, 2010

Last updated

Oct 8, 2015By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444262400000",
    "number": "1740511104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HIGHLAND AVE",
            "address_2": "COMPLIANCE MC 2433",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537920001",
            "telephone_number": "608-662-0817",
            "fax_number": "608-203-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W3985 COUNTY ROAD NN",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531214337",
            "telephone_number": "262-741-2145",
            "fax_number": "262-741-2559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACQUELINE",
        "middle_name": "MARY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-26",
        "last_updated": "2015-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "685422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED DIETITIAN",
            "identifier": "1508-029",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Kate Stephens, RD
• Patricia Lea Stern RN, RN
• James F Stewart II, MD
• Seve Strook, DPT
• Michele Stueve, M.D.
• Timothy Swanson, MS, LCPC, LPC
• Joseph Sweeney, PHARMD, BCPS
• Fares W Sweis, MD
• Martin Tanhaei
• Sonya Tesch, PTA

• Registered Dietitian in Elkhorn, WI
• Providers in Elkhorn, WI by specialty
• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; 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.