Provider Demographics
NPI:1356012504
Name:SULLIVAN, HANA WON (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:HANA
Middle Name:WON
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DENISON PKWY E STE 50
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2638
Mailing Address - Country:US
Mailing Address - Phone:607-542-9507
Mailing Address - Fax:607-377-5550
Practice Address - Street 1:8 DENISON PKWY E STE 50
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2638
Practice Address - Country:US
Practice Address - Phone:607-542-9507
Practice Address - Fax:607-377-5550
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310339363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health