Provider Demographics
NPI:1104468974
Name:SULLIVAN-MILLER, EMILY JOY (MS, CNP, CNS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JOY
Last Name:SULLIVAN-MILLER
Suffix:
Gender:F
Credentials:MS, CNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CENTENNIAL DR STE 204
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7930
Mailing Address - Country:US
Mailing Address - Phone:978-382-0237
Mailing Address - Fax:
Practice Address - Street 1:4 CENTENNIAL DR STE 204
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7930
Practice Address - Country:US
Practice Address - Phone:978-977-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2286257363L00000X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care