Healthcare Provider Details

I. General information

NPI: 1548677842
Provider Name (Legal Business Name): KATELYN SULLIVAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN BILLINGS APRN

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 STATE STREET
MERIDEN CT
06450-7044
US

IV. Provider business mailing address

134 STATE STREET
MERIDEN CT
06450-7044
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-2229
  • Fax: 203-686-1677
Mailing address:
  • Phone: 203-237-2229
  • Fax: 203-686-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5867
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number79521
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: