1780606962 NPI number — MRS. MARTHA CECILE SULLIVAN FNP

Table of content: MRS. MARTHA CECILE SULLIVAN FNP (NPI 1780606962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780606962 NPI number — MRS. MARTHA CECILE SULLIVAN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
MARTHA
Provider Middle Name:
CECILE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1780606962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 TURKEY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUNENBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01462-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-582-7031
Provider Business Mailing Address Fax Number:
508-793-3610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 COLLEGE ST.
Provider Second Line Business Practice Location Address:
THE COLLEGE OF THE HOLY CROSS HEALTH SERVICES
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-793-2276
Provider Business Practice Location Address Fax Number:
508-793-3610
Provider Enumeration Date:
07/24/2006

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:  142135 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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