Mary F Sullivan, FAMILY NURSE PRACTIT

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN124312 Issued in MA

Practice address

116 Belmont St
Suite 11
Worcester, MA 01605-2964

Phone

(508) 334-1102

NPI assigned

Aug 9, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393372800000",
    "number": "1043220049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 BELMONT ST",
            "address_2": "SUITE 11",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052964",
            "telephone_number": "508-334-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARY",
        "middle_name": "F",
        "credential": "FAMILY NURSE PRACTIT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2014-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "124312",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN124312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "NP1913",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0715930",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mariette Elizabeth Sullivan, B.S
• Martha Cecile Sullivan, FNP
• Martha M Sullivan, GENERAL DENTISTRY
• Mary Barbara Sullivan, PHARMD
• Mary E Sullivan, NP
• Mary M Sullivan, MPT
• Merissa Sullivan
• Nikki Lynn Sullivan
• Rachel R Sullivan
• Ryan Delano Sullivan, MD

• Nurse Practitioner in Worcester, MA
• Providers in Worcester, MA by specialty
• Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.