Individual
MRS. JESSICA JANE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
115 FRANKLIN AVE, NUTLEY, NJ 07110-2924
(973) 773-9250
Mailing address
23 W PARKWAY, PEQUANNOCK, NJ 07440-1709
(973) 452-1290
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00486200
NJ
Other
Enumeration date
09/12/2018
Last updated
09/12/2018
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