Provider Demographics
NPI:1902146715
Name:SULLIVAN, NANCY PETERS (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:PETERS
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-485-4161
Mailing Address - Fax:802-485-4163
Practice Address - Street 1:87 PAINE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5791
Practice Address - Country:US
Practice Address - Phone:802-485-4161
Practice Address - Fax:802-485-4163
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60249847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily