Individual
MRS. LEA M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
49 HARCOURT AVE, LAKEVILLE, MA 02347-1520
(508) 947-0685
Mailing address
49 HARCOURT AVE, LAKEVILLE, MA 02347-1520
(508) 947-0685
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
276129
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0718416
MASSHEALTH PROVIDER NUMBER
MA
Enumeration date
08/29/2008
Last updated
08/29/2008
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