Individual
MRS. LORRAINE LOUISE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1577 CONGRESS ST, 1ST FLOOR, PORTLAND, ME 04102-2169
(207) 662-1442
(207) 775-2467
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP81643
ME
363LP0200X
Pediatric Nurse Practitioner
R016719
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263670099
—
ME
Enumeration date
10/05/2006
Last updated
12/01/2014
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