Healthcare Provider Details

I. General information

NPI: 1336953603
Provider Name (Legal Business Name): PATRICIA LOUISE SULLIVAN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES ST
EDISON NJ
08820-3947
US

IV. Provider business mailing address

716 FIRETHORN DR
UNION NJ
07083-5075
US

V. Phone/Fax

Practice location:
  • Phone: 732-744-5955
  • Fax: 732-906-4967
Mailing address:
  • Phone: 732-744-5955
  • Fax: 732-906-4967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number10500500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: