Basic Information
| Provider Information | |||||||||
| NPI: | 1346442886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | RN, MS, FNP-C, ACRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1122 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024591543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888978947 | ||||||||
| FaxNumber: | 6177725519 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 NORTHAMPTON ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021184010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174339601 | ||||||||
| FaxNumber: | 6174456538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC1500X | 193826 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health |
No ID Information.