Provider Demographics
NPI:1780606962
Name:SULLIVAN, MARTHA CECILE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:CECILE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1446
Mailing Address - Country:US
Mailing Address - Phone:978-582-7031
Mailing Address - Fax:508-793-3610
Practice Address - Street 1:1 COLLEGE ST.
Practice Address - Street 2:THE COLLEGE OF THE HOLY CROSS HEALTH SERVICES
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-793-2276
Practice Address - Fax:508-793-3610
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA142135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily