Lucille Martha Sullivan, PA-C
Physician Assistant in Keyport, NJ. Individual provider (NPI-1).
NPI number1346834033
StatusActive
Last updated in NPPESMar 20, 2021
Details
- NPI
- 1346834033
- Entity type
- Individual (NPI-1)
- Name
- Lucille Martha Sullivan
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 24, 2021
- Certification date
- Mar 20, 2021
- Last updated
- Mar 20, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Practice location
250 Maple PlKeyport, NJ 07735-1144
Phone 732-739-1400
Mailing address
250 Maple PlKeyport, NJ 07735-1144
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