Provider Demographics
NPI:1649052887
Name:SULLIVAN, JENNIFER HANLON (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HANLON
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HARBORVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-2105
Mailing Address - Country:US
Mailing Address - Phone:781-706-6546
Mailing Address - Fax:
Practice Address - Street 1:19 HARBORVIEW DR
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-2105
Practice Address - Country:US
Practice Address - Phone:781-706-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272773163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)