Provider Demographics
NPI:1144264748
Name:SULLIVAN, JUDITH A (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1532 WHIPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1640
Mailing Address - Country:US
Mailing Address - Phone:650-367-5636
Mailing Address - Fax:650-367-5110
Practice Address - Street 1:170 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:REDWOOD PULMONARY MEDICAL ASSOC.
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-367-5636
Practice Address - Fax:650-367-5110
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11141363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner