Individual
JACQUELYN MARIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2301 ERWIN RD, DEPARTMENT OF SURGERY, DURHAM, NC 27705-4699
(919) 864-8111
Mailing address
2301 ERWIN RD, DEPARTMENT OF SURGERY, DURHAM, NC 27705-4699
(919) 864-8111
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
08877
OH
363LG0600X
Gerontology Nurse Practitioner
08877
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200191600
—
IN
Enumeration date
08/02/2005
Last updated
04/16/2017
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