Provider Demographics
NPI:1821342999
Name:SULLIVAN, AMBER (CRNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4507
Mailing Address - Country:US
Mailing Address - Phone:301-302-9412
Mailing Address - Fax:
Practice Address - Street 1:1000 TAVERN RD STE 100
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2853
Practice Address - Country:US
Practice Address - Phone:304-267-9355
Practice Address - Fax:304-267-9358
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV102160363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily