KATHLEEN MARIE SULLIVAN NP NPI 1376811828

NPI Information

NPI: 1376811828
Provider Name: KATHLEEN MARIE SULLIVAN, NP
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

Organization: EVANS MEDICAL FOUNDATION INC

PECOS Registration: Yes

Address:
830 HARRISON AVE
MOAKLEY, 2ND FLOOR
BOSTON, MA
ZIP 02118
Phone: (617) 638-6525
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Kathleen Marie Sullivan, NP is an adult health nurse practitioner in Boston, MA with 13 years of experience. Kathleen Marie Sullivan, NP NPI is 1376811828. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

830 HARRISON AVE
MOAKLEY, 2ND FLOOR
BOSTON, MA
ZIP 02118-905
Phone: (617) 638-6525
Fax: (617) 638-7448

The NPI 1376811828 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/12/2011 and was last updated on 4/28/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	RN2259252	MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	110091798A	MEDICAID	MASSACHUSETTS
2	00255292	MEDICARE PIN	MASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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