Provider Demographics
NPI:1285781880
Name:SULLIVAN, LOUISE J (ANP-BC)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1972
Mailing Address - Country:US
Mailing Address - Phone:800-770-3651
Mailing Address - Fax:860-510-0020
Practice Address - Street 1:10 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1972
Practice Address - Country:US
Practice Address - Phone:800-770-3651
Practice Address - Fax:860-510-0020
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211116363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health