Provider Demographics
NPI:1982051728
Name:SULLIVAN, PAIGE ANN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-8901
Mailing Address - Fax:907-729-6353
Practice Address - Street 1:400 W BENSON BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3829
Practice Address - Country:US
Practice Address - Phone:907-729-5418
Practice Address - Fax:907-729-8607
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX858292363LP0808X
AK183298363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health