Provider Demographics
NPI:1558138586
Name:SULLIVAN, NANCY (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 OLD LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3203
Mailing Address - Country:US
Mailing Address - Phone:610-505-5555
Mailing Address - Fax:
Practice Address - Street 1:855 OLD LANCASTER RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3203
Practice Address - Country:US
Practice Address - Phone:610-505-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach