1568950152 NPI number — MRS. DEBORAH HALL SULLIVAN REGISTERED NURSE

Table of content: MRS. DEBORAH HALL SULLIVAN REGISTERED NURSE (NPI 1568950152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568950152 NPI number — MRS. DEBORAH HALL SULLIVAN REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
DEBORAH
Provider Middle Name:
HALL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568950152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 MITCHELL PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE SILVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07739-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-836-0122
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 SANGER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANPORT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07757-1241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-836-0122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2018

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: 163WN1003X , with the licence number:  26NR19834200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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