Healthcare Provider Details

I. General information

NPI: 1245259134
Provider Name (Legal Business Name): KAREN A SULLIVAN CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN A STEWART CNM

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HEALTHCARE DR STE 101
BIDDEFORD ME
04005-9445
US

IV. Provider business mailing address

9 HEALTHCARE DR STE 101
BIDDEFORD ME
04005-9445
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-4270
  • Fax: 207-294-8332
Mailing address:
  • Phone: 207-282-4270
  • Fax: 207-294-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP121054
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM82012
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: