Brian Daniel Sullivan, RN

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

RN644439 Issued in PA

Practice address

397 Hemlock Dr
Lehighton, PA 18235-9712

Phone

(570) 386-5522

NPI assigned

Apr 26, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1467034819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 HEMLOCK DR",
            "city": "LEHIGHTON",
            "state": "PA",
            "postal_code": "182359712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 HEMLOCK DR",
            "city": "LEHIGHTON",
            "state": "PA",
            "postal_code": "182359712",
            "telephone_number": "570-386-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "BRIAN",
        "middle_name": "DANIEL",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "PA",
            "license": "RN644439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "don@mvnrc.org",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "397 Hemlock Dr",
            "city": "Lehighton",
            "state": "PA",
            "country_code": "US",
            "postal_code": "182359712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Gerontology Registered Nurse in Lehighton, PA
• Providers in Lehighton, PA by specialty
• Gerontology Registered Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; 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.