Provider Demographics
NPI:1952650236
Name:SULLIVAN, LISA ANN (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SULLIVAN
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Gender:F
Credentials:NP
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Mailing Address - Street 1:3998 FAIR RIDGE DRIVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-766-9737
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:3998 FAIR RIDGE DR
Practice Address - Street 2:STE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2907
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2015-03-25
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Provider Licenses
StateLicense IDTaxonomies
DCRN58779363LA2100X
VA0024171328363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care