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General NPI Number Information
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NPI Number | 1780606962
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Entity Type | Individual
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Provider Name | MARTHA CECILE SULLIVAN FNP
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Gender | Female
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 COLLEGE ST. THE COLLEGE OF THE HOLY CROSS HEALTH SERVICES
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City | WORCESTER
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State | MA
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Zip | 01610
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Country | US
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Telephone | 508-793-2276
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Fax | 508-793-3610
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Provider Business Mailing Address
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Address Line | 111 TURKEY HILL RD
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City | LUNENBURG
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State | MA
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Zip | 01462-1446
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Country | US
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Telephone | 978-582-7031
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Fax | 508-793-3610
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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 | 142135
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License Number State | MA
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