Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 1120493 | NH |
NPI | 1609192970 |
---|---|
Provider Name | Jerrilyn N Sullivan |
First Address | Nashua, NH 03060-3576 |
Second Address | Nashua, NH 03060-3576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 14/04/2010 |