Sullivan, Jacqueline Yvonne

Sullivan, Jacqueline Yvonne is an individual health care provider with primary practice located at 1165 Imperial Dr Ste 200 , Hagerstown MD 21740-6583. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Sullivan, Jacqueline Yvonne can be contacted via phone (301) 665-9098.

Contact Information

Primary practice address
1165 Imperial Dr Ste 200 Hagerstown MD 21740-6583
Phone: (301) 665-9098
Fax: (301) 665-9096
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X MW010272 Pennsylvania

Profile Details

NPI number 1679847107
LBN Legal business name Sullivan, Jacqueline Yvonne
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2012
Last updated Dec 1st, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679847107 NPPES
Pennsylvania MEDICAID 102733511

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