Healthcare Provider Details

I. General information

NPI: 1881456721
Provider Name (Legal Business Name): LAUREN MICHELLE SULLIVAN RN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

35 WINTERBERRY LN
TEWKSBURY MA
01876-4274
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3794
  • Fax:
Mailing address:
  • Phone: 617-894-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN2261895
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN2261895
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: