Individual
NANCI JACQULYN SULLIVAN-BLACKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, CDE, NP-C
Contact information
Practice address
3604 BUSH ST, RALEIGH, NC 27609-7511
(919) 876-7807
(919) 459-8402
Mailing address
3604 BUSH ST, RALEIGH, NC 27609-7511
(919) 876-7807
(919) 459-8402
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5005832
NC
363LF0000X
Family Nurse Practitioner
F0512372
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568718336
HNFS/TRICARE
—
05
—
1568718336
—
NC
01
—
FH4001480
FIRST CAROLINA CARE, INC
NC
Enumeration date
07/31/2012
Last updated
08/11/2016
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