Provider Demographics
NPI:1811236565
Name:SULLIVAN, TIAMARIE (LPN)
Entity Type:Individual
Prefix:
First Name:TIAMARIE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:E ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-2243
Mailing Address - Country:US
Mailing Address - Phone:585-314-1792
Mailing Address - Fax:
Practice Address - Street 1:219 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:E ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2243
Practice Address - Country:US
Practice Address - Phone:585-314-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312940164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse