Individual
JESSICA PAGE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP-PMH
Contact information
Practice address
10 W MADISON ST STE 11, BALTIMORE, MD 21201
(443) 438-7863
Mailing address
10 W MADISON ST STE 11, BALTIMORE, MD 21201-2313
(443) 438-7863
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R192427
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086453600
—
MD
Enumeration date
08/13/2014
Last updated
08/16/2018
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