Provider Demographics
NPI:1245259134
Name:SULLIVAN, KAREN A (CNM, FNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:9 HEALTHCARE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9445
Mailing Address - Country:US
Mailing Address - Phone:207-282-4270
Mailing Address - Fax:207-294-8332
Practice Address - Street 1:9 HEALTHCARE DR STE 101
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9445
Practice Address - Country:US
Practice Address - Phone:207-282-4270
Practice Address - Fax:207-294-8332
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121054363LF0000X
MECNM82012367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME404090099Medicaid
ME404090099Medicaid