Individual
MARY F SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FAMILY NURSE PRACTIT
Contact information
Practice address
116 BELMONT ST, SUITE 11, WORCESTER, MA 01605-2964
(508) 334-1102
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN124312
MA
363LF0000X
Family Nurse Practitioner
124312
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0715930
—
MA
01
—
NP1913
BCBS
MA
Enumeration date
08/09/2006
Last updated
02/26/2014
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