Healthcare Provider Details

I. General information

NPI: 1013199801
Provider Name (Legal Business Name): VIRGINIA SULLIVAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 1000
FPO AE
09617
IT

IV. Provider business mailing address

PSC 827 BOX 245
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 390818116000
  • Fax:
Mailing address:
  • Phone: 81-811-6471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN556936
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: