MEDICARE: GINGER K O'SULLIVAN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SN0800X	Neuroscience Clinical Nurse Specialist	RN284653L	PA

General Provider Information

NPI Number	:	1104917335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINGER K O'SULLIVAN CRNP

Provider Business Mailing Address
First Line	:	PO BOX 1754
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18105-1754
Country	:	US
Telephone Number	:	610-798-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 S CEDAR CREST BLVD
Second Line	:	SUITE 1800
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6229
Country	:	US
Telephone Number	:	610-402-8420
Fax Number	:	610-402-1689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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