Provider Demographics
NPI:1447769468
Name:O'SULLIVAN, CYNTHIA KLINE (APRN)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:KLINE
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:SUE
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:30 HIGHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2554
Mailing Address - Country:US
Mailing Address - Phone:203-216-2945
Mailing Address - Fax:203-318-1898
Practice Address - Street 1:30 HIGHVIEW RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2554
Practice Address - Country:US
Practice Address - Phone:203-216-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12.007030OtherAPRN LICENSE NUMBER