Provider Demographics
NPI:1497843239
Name:SULLIVAN, JUSTINE (CRNFA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ELM DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8840
Mailing Address - Country:US
Mailing Address - Phone:973-957-0548
Mailing Address - Fax:866-395-0888
Practice Address - Street 1:13 ELM DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8840
Practice Address - Country:US
Practice Address - Phone:973-957-0548
Practice Address - Fax:866-395-0888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO05331500163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant