Individual
JENNIFER SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 WAKE FOREST RD, RALEIGH, NC 27609-7317
(617) 595-2739
Mailing address
929 GABRIEL DR APT 104, GREENVILLE, NC 27834-2196
(617) 595-2739
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN2328056
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2328056
MA
Other
Enumeration date
06/11/2019
Last updated
03/29/2026
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