Individual
MARYELLEN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
950 WINTER STREET, WALTHAM, MA 02451
(781) 472-8787
Mailing address
1200 CENTRE ST, DEPT. OF MEDICINE, ROSLINDALE, MA 02131-1011
(617) 363-8010
(617) 363-8929
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
142612
MA
Other
Enumeration date
02/23/2006
Last updated
09/17/2015
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