Provider Demographics
NPI:1265070783
Name:SULLIVAN, ERIN CATHERINE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:CATHERINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 166
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6135
Mailing Address - Country:US
Mailing Address - Phone:978-712-3360
Mailing Address - Fax:
Practice Address - Street 1:12 INGALLS CT
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3712
Practice Address - Country:US
Practice Address - Phone:978-686-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310113363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2310113OtherOTHER