Provider Demographics
NPI:1346442886
Name:SULLIVAN, PATRICIA (RN, MS, FNP-C, ACRN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN, MS, FNP-C, ACRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1543
Mailing Address - Country:US
Mailing Address - Phone:888-897-8947
Mailing Address - Fax:617-772-5519
Practice Address - Street 1:30 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4010
Practice Address - Country:US
Practice Address - Phone:617-433-9601
Practice Address - Fax:617-445-6538
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193826363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health