Individual
KATHLEEN LEA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
134 GRANDVIEW AVE, 208, WATERBURY, CT 06708-2507
(203) 755-3279
(203) 755-3057
Mailing address
134 GRANDVIEW AVE, 208, WATERBURY, CT 06708-2507
(203) 755-3279
(203) 755-3057
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4478
CT
363LP0200X
Pediatric Nurse Practitioner
004478
CT
Other
Enumeration date
09/09/2010
Last updated
04/01/2015
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