Healthcare Provider Details

I. General information

NPI: 1295299097
Provider Name (Legal Business Name): HANNAH SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 STEVES LN
MARSHFIELD ME
04654-5045
US

IV. Provider business mailing address

PO BOX 1018
CARIBOU ME
04736-1018
US

V. Phone/Fax

Practice location:
  • Phone: 207-255-0996
  • Fax: 207-255-8748
Mailing address:
  • Phone: 207-498-6431
  • Fax: 207-492-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: