Healthcare Provider Details

I. General information

NPI: 1477805752
Provider Name (Legal Business Name): BARBARA ANN SULLIVAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EMILY ST
HAVERHILL MA
01832-3031
US

IV. Provider business mailing address

30 EMILY ST
HAVERHILL MA
01832-3031
US

V. Phone/Fax

Practice location:
  • Phone: 978-766-4273
  • Fax:
Mailing address:
  • Phone: 978-766-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number146034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: