Healthcare Provider Details

I. General information

NPI: 1992609895
Provider Name (Legal Business Name): EMILIE SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BIRCH DR
SANDOWN NH
03873-2500
US

IV. Provider business mailing address

23 BIRCH DR
SANDOWN NH
03873-2500
US

V. Phone/Fax

Practice location:
  • Phone: 978-914-4684
  • Fax:
Mailing address:
  • Phone: 978-914-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number087584-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: