Provider Demographics
NPI:1366715559
Name:SULLIVAN, COLLEEN JEAN (LPN)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:JEAN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MUTTON LN
Mailing Address - Street 2:APT 2
Mailing Address - City:EAST WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2434
Mailing Address - Country:US
Mailing Address - Phone:508-728-3686
Mailing Address - Fax:
Practice Address - Street 1:173 MUTTON LN
Practice Address - Street 2:APT 2
Practice Address - City:EAST WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-2434
Practice Address - Country:US
Practice Address - Phone:508-728-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN67421164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse