Healthcare Provider Details

I. General information

NPI: 1609148659
Provider Name (Legal Business Name): ANNE MARIE SULLIVAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

12 SHADY LANE DR
WILMINGTON MA
01887-1937
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-3311
  • Fax:
Mailing address:
  • Phone: 978-610-2165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number181702
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: