Individual
ELAINE MARY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
161 EASTERN AVE, LYNN, MA 01902-1307
(781) 502-8558
Mailing address
161 EASTERN AVE, LYNN, MA 01902-1307
(781) 502-8558
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
4891
MA
Other
Enumeration date
01/10/2011
Last updated
01/10/2011
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