Individual
LAUREN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
10 STONEWALL DR, QUEENSBURY, NY 12804-7719
(617) 680-1093
Mailing address
10 STONEWALL DR, QUEENSBURY, NY 12804-7719
(617) 680-1093
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
732271
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F403519
NY
Other
Enumeration date
11/06/2017
Last updated
06/13/2021
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