Active NPI
Lisa Sullivan, N.P.
- Nurse Practitioner
- Utica, NY
National Provider Identifier
1922081199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- F301118-1
- Practice address
- 110 Business Park Dr
Utica, NY 13502-6302 - Phone
- (315) 624-7000
- Fax
- (315) 735-5226
- NPI assigned
- Nov 22, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | F301118-1 | NY | Primary |
Addresses
Primary practice location
110 Business Park Dr
Utica, NY 13502-6302
Mailing address
110 Business Park Dr
Utica, NY 13502-6302
Phone (315) 624-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 301118 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278547200000",
"number": "1922081199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 BUSINESS PARK DR",
"city": "UTICA",
"state": "NY",
"postal_code": "135026302",
"telephone_number": "315-624-7000",
"fax_number": "315-735-5226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 BUSINESS PARK DR",
"city": "UTICA",
"state": "NY",
"postal_code": "135026302",
"telephone_number": "315-624-7000",
"fax_number": "315-735-5226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "LISA",
"name_prefix": "Mrs.",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-22",
"last_updated": "2010-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NY",
"license": "F301118-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Utica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.