Individual
MRS. PATRICIA MARY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS RD LDN
Contact information
Practice address
6083 HAMILTON BOULEVARD, WESCOSVILLE, PA 18106
(610) 597-1512
Mailing address
5393 PRINCETON ROAD, MACUNGIE, PA 18062
(610) 509-9383
(610) 965-7878
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN002548
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3762201
AETNA LIFE INSURANCE COMP
—
01
—
SU1794305
HIGHMARK BLUE SHIELD
PA
Enumeration date
06/15/2007
Last updated
07/08/2007
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