Provider Demographics
NPI:1679018709
Name:SULLIVAN, ANN MARIE (RN, APN)
Entity Type:Individual
Prefix:MS
First Name:ANN MARIE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2654
Mailing Address - Country:US
Mailing Address - Phone:732-371-4400
Mailing Address - Fax:
Practice Address - Street 1:530 GREEN ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2654
Practice Address - Country:US
Practice Address - Phone:732-371-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00455100363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics