Provider Demographics
NPI:1346609955
Name:SULLIVAN, MONIKA MAGDALENA (APRN)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:MAGDALENA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:MAGDALENA
Other - Last Name:MRUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:122 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-583-1800
Mailing Address - Fax:860-584-4256
Practice Address - Street 1:122 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-583-1800
Practice Address - Fax:860-584-4256
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2287807363LW0102X
CT6466363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health