Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 193826 | MA |
NPI | 1346442886 |
---|---|
Provider Name | Patricia Sullivan |
First Address | Newton, MA 02459-1543 |
Second Address | Boston, MA 02118-4010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 17/03/2018 |