Provider Demographics
NPI:1982706180
Name:SULLIVAN, DOROTHY A (NP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DEDE
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:280 MERRIMACK ST STE 311
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1779
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5693
Practice Address - Street 1:784 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2549
Practice Address - Country:US
Practice Address - Phone:603-742-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056917-23363L00000X, 363LA2200X
MA255102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344720Medicaid
NH3076281Medicaid
NHNP5498Medicare PIN