Provider Demographics
NPI:1144827585
Name:SULLIVAN, CATHERINE B (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:B
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 FORRESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2930
Mailing Address - Country:US
Mailing Address - Phone:336-448-9100
Mailing Address - Fax:336-778-7995
Practice Address - Street 1:3821 FORRESTGATE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2930
Practice Address - Country:US
Practice Address - Phone:336-448-9100
Practice Address - Fax:336-778-7995
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015778363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health