Provider Demographics
NPI:1093179962
Name:SULLIVAN, MORGAN (NP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1317
Mailing Address - Country:US
Mailing Address - Phone:585-768-2620
Mailing Address - Fax:585-768-2694
Practice Address - Street 1:127 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1317
Practice Address - Country:US
Practice Address - Phone:585-768-2620
Practice Address - Fax:585-768-2694
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639696163W00000X
NY307737363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400325929Medicare PIN