Provider Demographics
NPI:1124365812
Name:SULLIVAN, DENNIS PATRICK (LPN)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:PATRICK
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13408-1415
Mailing Address - Country:US
Mailing Address - Phone:315-345-8307
Mailing Address - Fax:315-684-7719
Practice Address - Street 1:4975 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NY
Practice Address - Zip Code:13408-1415
Practice Address - Country:US
Practice Address - Phone:315-345-8307
Practice Address - Fax:315-684-7719
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313258164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse