Provider Demographics
NPI:1063547669
Name:SULLIVAN, MARJORIE OLSEN (MSN,APRN,BC)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:OLSEN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSN,APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6811
Mailing Address - Country:US
Mailing Address - Phone:781-235-4803
Mailing Address - Fax:781-237-5507
Practice Address - Street 1:231 FOREST STREET
Practice Address - Street 2:BABSON COLLEGE HEALTH SERVICES
Practice Address - City:BABSON PARK
Practice Address - State:MA
Practice Address - Zip Code:02457-0310
Practice Address - Country:US
Practice Address - Phone:781-239-4257
Practice Address - Fax:781-239-5069
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA135918363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health