Provider Demographics
NPI:1659309086
Name:SULLIVAN, KATHY HOLLENBAUGH (RN, MSN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:HOLLENBAUGH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 BIDDLE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3969
Mailing Address - Country:US
Mailing Address - Phone:302-838-4774
Mailing Address - Fax:302-838-4793
Practice Address - Street 1:300 BIDDLE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3969
Practice Address - Country:US
Practice Address - Phone:302-838-4700
Practice Address - Fax:302-838-4793
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELB0000194363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health