Provider Demographics
NPI:1164949509
Name:SULLIVAN, LINDA HUTTIG (PNP-PC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:HUTTIG
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1414
Mailing Address - Country:US
Mailing Address - Phone:978-975-2203
Mailing Address - Fax:
Practice Address - Street 1:499 WINTER ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1414
Practice Address - Country:US
Practice Address - Phone:978-975-2203
Practice Address - Fax:978-975-2203
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151655363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics