Healthcare Provider Details

I. General information

NPI: 1346609955
Provider Name (Legal Business Name): MONIKA MAGDALENA SULLIVAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIKA MAGDALENA MRUK APRN

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325B KING ST
NORTHAMPTON MA
01060-2370
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-2496
  • Fax: 413-923-5557
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2287807
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: