Individual
MRS. JESSICA GWENHWYVAR SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
495 SUMMER ST, BOSTON MEPS, 4TH FLOOR, BOSTON, MA 02210-2109
(617) 753-3113
Mailing address
495 SUMMER STREET, BOSTON MEPS, 4TH FLOOR, BOSTON, MA 01721
(617) 753-3113
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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