Provider Demographics
NPI:1629239538
Name:SULLIVAN, EMILY K (PAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:K
Other - Last Name:STRATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2746
Mailing Address - Country:US
Mailing Address - Phone:603-926-0088
Mailing Address - Fax:603-926-2853
Practice Address - Street 1:380 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2222
Practice Address - Country:US
Practice Address - Phone:603-926-0088
Practice Address - Fax:603-926-2853
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0665363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30337021Medicaid
NH0007853Medicare PIN