Tara Roberta Sullivan, RN,IBCLC,LCCE

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

4704245099 Issued in MI

Practice address

24808 Boston St
Dearborn, MI 48124-4411

Phone

(313) 618-4206

NPI assigned

May 31, 2020

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

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1590883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590883200000",
    "number": "1841814456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24808 BOSTON ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244411",
            "telephone_number": "313-618-4206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24808 BOSTON ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244411",
            "telephone_number": "313-618-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TARA",
        "middle_name": "ROBERTA",
        "name_prefix": "Mrs.",
        "credential": "RN,IBCLC,LCCE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-31",
        "last_updated": "2020-05-31",
        "certification_date": "2020-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "MI",
            "license": "4704245099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin M Suiter, MD
• Jiab Suleiman, DO
• Dominique Sulla
• Jaymie Elizabeth Sullins
• Laura Ann Sullivan, MD
• Zillay Huma Sultan, PA-C
• Onita Marshea Sumler
• Amanda Lee Summerfield, NP
• Summit Home Care, LLC
• Rachel Sumner, RD

• Lactation Consultant (Registered Nurse) in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Lactation Consultant (Registered Nurse) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2020; 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.