Provider Demographics
NPI:1518688373
Name:SULLIVAN, ANGELA D (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 58TH AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1936
Mailing Address - Country:US
Mailing Address - Phone:240-464-4033
Mailing Address - Fax:
Practice Address - Street 1:4237 58TH AVE APT 10
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1936
Practice Address - Country:US
Practice Address - Phone:240-464-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program