Provider Demographics
NPI:1376308809
Name:SULLIVAN, CHRISTINE VERONICA (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:VERONICA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 STANTON CHRISTIANA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2134
Mailing Address - Country:US
Mailing Address - Phone:302-600-1124
Mailing Address - Fax:
Practice Address - Street 1:620 STANTON CHRISTIANA RD STE 101
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2134
Practice Address - Country:US
Practice Address - Phone:302-600-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily