Provider Demographics
NPI:1356012504
Name:SULLIVAN, HANA WON (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:WON
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W WELLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1411
Mailing Address - Country:US
Mailing Address - Phone:570-662-1945
Mailing Address - Fax:
Practice Address - Street 1:103 FORESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:ELKLAND
Practice Address - State:PA
Practice Address - Zip Code:16920-1403
Practice Address - Country:US
Practice Address - Phone:814-258-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025814363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health