Healthcare Provider Details

I. General information

NPI: 1093179962
Provider Name (Legal Business Name): MORGAN SULLIVAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W MAIN ST
LE ROY NY
14482-1317
US

IV. Provider business mailing address

127 W MAIN ST
LE ROY NY
14482-1317
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-2620
  • Fax: 585-768-2694
Mailing address:
  • Phone: 585-768-2620
  • Fax: 585-768-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number639696
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: