MEDICARE: MARIANNE T SULLIVAN ANP

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	363LA2200X	Adult Health Nurse Practitioner	RN188992	MA

General Provider Information

NPI Number	:	1811137532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE T SULLIVAN ANP

Provider Business Mailing Address
First Line	:	285 OLD WESTPORT RD
Second Line	:	HEALTH SERVICES
City	:	NORTH DARTMOUTH
State	:	MA
Zip	:	02747-2356
Country	:	US
Telephone Number	:	508-999-8982
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 OLD WESTPORT RD
Second Line	:	HEALTH SERVICES
City	:	NORTH DARTMOUTH
State	:	MA
Zip	:	02747-2356
Country	:	US
Telephone Number	:	508-999-8982
Fax Number	:

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

Provider Enumeration Date	:	02/21/2009
Last Update Date	:	06/13/2012

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