Individual
KELLY ELIZABETH SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
428 HARTFORD TPKE STE 207, VERNON, CT 06066-4841
(860) 872-5426
Mailing address
428 HARTFORD TPKE STE 207, VERNON, CT 06066-4841
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
390200000X
CT
Other
Enumeration date
05/19/2018
Last updated
05/19/2018
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