Provider Demographics
NPI:1205511508
Name:SULLIVAN, ABIGAIL J (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 NEWPORT RD # 107
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5468
Mailing Address - Country:US
Mailing Address - Phone:603-526-4144
Mailing Address - Fax:
Practice Address - Street 1:276 NEWPORT RD # 107
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257
Practice Address - Country:US
Practice Address - Phone:603-526-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH074008-21163W00000X
NH074008-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse