Individual
MRS. JACQUELINE ROSE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
520 W FAYETTE ST STE 300, BALTIMORE, MD 21201-1756
(724) 422-2261
Mailing address
36525 KIDWELL RD, HILLSBORO, VA 20132-1701
(724) 422-2261
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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