Individual
LUCILLE MARTHA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
250 MAPLE PL, KEYPORT, NJ 07735-1144
(732) 739-1400
Mailing address
250 MAPLE PL, KEYPORT, NJ 07735-1144
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/24/2021
Last updated
03/20/2021
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