Healthcare Provider Details

I. General information

NPI: 1265070783
Provider Name (Legal Business Name): ERIN CATHERINE SULLIVAN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 INGALLS CT
METHUEN MA
01844-3712
US

IV. Provider business mailing address

100 CUMMINGS CTR STE 166
BEVERLY MA
01915-6135
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-2807
  • Fax:
Mailing address:
  • Phone: 978-712-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2310113
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: