Provider Demographics
NPI:1265879191
Name:SULLIVAN, VICTORIA FELLOWS (MSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:FELLOWS
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 1:102 MCGUFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1131
Mailing Address - Country:US
Mailing Address - Phone:540-271-0773
Mailing Address - Fax:
Practice Address - Street 1:1661 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2728
Practice Address - Country:US
Practice Address - Phone:540-564-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily