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General NPI Number Information
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NPI Number | 1265433122
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Entity Type | Individual
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Provider Name | LAURA D SULLIVAN CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 363 HIGHLAND AVE
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City | FALL RIVER
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State | MA
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Zip | 02720-3703
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Country | US
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Telephone | 508-679-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 53 TALLAWANDA RD STE. 670
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City | SWANSEA
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State | MA
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Zip | 02777-1206
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Country | US
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Telephone | 508-567-1969
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 256715
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 001968
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License Number State | CT
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