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General NPI Number Information
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NPI Number | 1063077352
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Entity Type | Individual
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Provider Name | NINA SULLIVAN NP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 7240 COURTLAND FARM RD
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City | HANOVER
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State | VA
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Zip | 23069-1564
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Country | US
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Telephone | 804-365-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 8072 PEBBLEPATH PKWY
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-7500
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Country | US
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Telephone | 804-245-2543
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024177556
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License Number State | VA
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