Judith Eileen Sullivan, ANP

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

License

CNS36A Issued in ID

Practice address

223 W State St
Boise, ID 83702-6013

Phone

(208) 343-0436

NPI assigned

May 8, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1210204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210204800000",
    "number": "1083880181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 GOLDEN EAGLE DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837163217",
            "telephone_number": "208-343-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026013",
            "telephone_number": "208-343-0436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JUDITH",
        "middle_name": "EILEEN",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-08",
        "last_updated": "2008-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "ID",
            "license": "CNS36A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Suida, CRNP
• Michael Joseph Suida, CRNA
• C Eugene Sullivan, M.D.
• Casey Margaret Sullivan, LMSW
• Heather Leslie Sullivan, OT
• Katherine Sullivan
• Lisa Sullivan
• Richard Lee Sullivan, M.D.
• Sandra Sullivan
• Timothy J Sullivan

• Psychiatric/Mental Health Clinical Nurse Specialist in Boise, ID
• Providers in Boise, ID by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; 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.