Provider Demographics
NPI:1568950152
Name:SULLIVAN, DEBORAH HALL (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:HALL
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:ANNE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:75 MITCHELL PL
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1607
Mailing Address - Country:US
Mailing Address - Phone:917-836-0122
Mailing Address - Fax:
Practice Address - Street 1:1000 SANGER AVE
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1241
Practice Address - Country:US
Practice Address - Phone:917-836-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR19834200163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support