Provider Demographics
NPI:1891297255
Name:SULLIVAN, CHRISTINE LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LEE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:50 UNION ST.
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1586
Mailing Address - Country:US
Mailing Address - Phone:207-664-5672
Mailing Address - Fax:207-664-5963
Practice Address - Street 1:50 UNION ST.
Practice Address - Street 2:SUITE 3500
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1586
Practice Address - Country:US
Practice Address - Phone:207-664-5672
Practice Address - Fax:207-664-5963
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1783363A00000X
MEPAN1783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant