Provider Demographics
NPI:1437177417
Name:OSULLIVAN, ANN LAWRENCE (PHD CRNP FAAN)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:LAWRENCE
Last Name:OSULLIVAN
Suffix:
Gender:F
Credentials:PHD CRNP FAAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4219
Mailing Address - Country:US
Mailing Address - Phone:215-285-1071
Mailing Address - Fax:215-573-7496
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-590-5035
Practice Address - Fax:215-590-5048
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000285D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics