1235227539 NPI number — MARGARET G SULLIVAN NP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235227539 NPI number — MARGARET G SULLIVAN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
MARGARET
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235227539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 HAYES AVE
Provider Second Line Business Mailing Address:
BLDG. A
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44870-7248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-626-6161
Provider Business Mailing Address Fax Number:
419-626-7030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1326 E PERKINS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44870-5025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-625-5065
Provider Business Practice Location Address Fax Number:
419-621-1276
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP09095 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2703739 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: NP09095 . This is a "CERTIFIED NURSE PRACTITIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: RN265442 . This is a "REGISTERED NURSE 1" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com