Provider Demographics
NPI:1851494991
Name:SULLIVAN, BARBARA ANN GRACE (PHD APRN)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN GRACE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 OLD KINGS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06247
Mailing Address - Country:US
Mailing Address - Phone:860-455-2099
Mailing Address - Fax:
Practice Address - Street 1:7 VAUXHALL ST
Practice Address - Street 2:CHILD & FAMILY AGENCY OF SOUTHEASTERN CT INC
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-442-2797
Practice Address - Fax:860-701-3776
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR42162163W00000X
CT000924163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics