1508351024 NPI number — DR. ATINA LORENE SULLIVAN NURSE PRACTITIONER

Table of content: DR. ATINA LORENE SULLIVAN NURSE PRACTITIONER (NPI 1508351024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508351024 NPI number — DR. ATINA LORENE SULLIVAN NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
ATINA
Provider Middle Name:
LORENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COVINGTON
Provider Other First Name:
ATINA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508351024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3205 DORSTONE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER MARLBORO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-8099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-673-6928
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1202 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODENTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21113-1397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-672-2862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2018

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: 363LP0808X , with the licence number:  R250751 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com