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NPI Code Detail

MEDICARE: MS. COLLEEN JEAN SULLIVAN LPN

MEDICARE: MS. COLLEEN JEAN SULLIVAN LPN
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
1164W00000XLicensed Practical NurseLN67421MA

General Provider Information

NPI Number : 1366715559
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COLLEEN JEAN SULLIVAN LPN
Provider Business Mailing Address
First Line : 173 MUTTON LN
Second Line : APT 2
City : EAST WEYMOUTH
State : MA
Zip : 02189-2434
Country : US
Telephone Number : 508-728-3686
Fax Number :
Provider Business Practice Location Address
First Line : 173 MUTTON LN
Second Line : APT 2
City : EAST WEYMOUTH
State : MA
Zip : 02189-2434
Country : US
Telephone Number : 508-728-3686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2012
Last Update Date : 02/17/2012

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