Provider Demographics
NPI:1407130131
Name:SULLIVAN, GRACE CATHERINE (APRN, DNSC)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:CATHERINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN, DNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:49 PINEHURST RD
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-0976
Mailing Address - Country:US
Mailing Address - Phone:508-939-9122
Mailing Address - Fax:
Practice Address - Street 1:9 CRESTSHIRE LN
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1001
Practice Address - Country:US
Practice Address - Phone:978-969-9739
Practice Address - Fax:978-258-2682
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124111NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health