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NPI Code Detail

MEDICARE: MS. ABBEY ROSE SULLIVAN FNP

MEDICARE: MS. ABBEY ROSE SULLIVAN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerLG-0013520DE
2363LF0000XFamily Nurse Practitioner2311788MA
3363L00000XNurse PractitionerCNP251152ME
4390200000XStudent in an Organized Health Care Education/Training Program
5363LF0000XFamily Nurse Practitioner11038098FL
6363L00000XNurse Practitioner113823-23NH
7363L00000XNurse Practitioner4035992KY
8363L00000XNurse Practitioner53-84146-101KS
9363LF0000XFamily Nurse Practitioner0039137OH

General Provider Information

NPI Number : 1780258848
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ABBEY ROSE SULLIVAN FNP
Provider Business Mailing Address
First Line : 85 HIGH ST
Second Line :
City : MEDFORD
State : MA
Zip : 02155-3825
Country : US
Telephone Number : 617-244-0858
Fax Number :
Provider Business Practice Location Address
First Line : 85 HIGH ST
Second Line :
City : MEDFORD
State : MA
Zip : 02155-3825
Country : US
Telephone Number : 663-892-7278
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2021
Last Update Date : 03/23/2026

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