Healthcare Provider Details

I. General information

NPI: 1063949048
Provider Name (Legal Business Name): LYNN THUY SULLIVAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN THUY NGUYEN APRN

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BURNET AVE
CINCINNATI OH
45229-3014
US

IV. Provider business mailing address

1527 MARYLAND AVE
COVINGTON KY
41014-1333
US

V. Phone/Fax

Practice location:
  • Phone: 513-907-2887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.023501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: