Basic Information
| Provider Information | |||||||||
| NPI: | 1134895931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | BRIANNE | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150711234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124989810 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY DRIVE C | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152401003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664827488 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2021 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN644877 | PA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.