Sullivan, Jacquelyn Marie

Sullivan, Jacquelyn Marie is an individual health care provider with primary practice located at 2301 Erwin Rd Department Of Surgery, Durham NC 27705-4699. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Acute Care is her primary health care specialty. Sullivan, Jacquelyn Marie can be contacted via phone (919) 864-8111.

Contact Information

Primary practice address
2301 Erwin Rd Department Of Surgery Durham NC 27705-4699
Phone: (919) 864-8111
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 08877 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 08877 Ohio

Profile Details

NPI number 1912908740
LBN Legal business name Sullivan, Jacquelyn Marie
Credentials NURSE PRACTITIONER
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2005
Last updated Apr 16th, 2017 - about 9 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 1912908740 NPPES
Indiana MEDICAID 200191600

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