KATHLEEN MARIE SULLIVAN (NPI# 1376811828) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376811828 |
| Entity Type | Individual |
| Full Name | KATHLEEN MARIE SULLIVAN |
| Credential | NP |
| Practice Address |
830 Harrison Ave Moakley, 2nd Floor Boston MA 02118-2905 |
| Mailing Address |
720 Harrison Ave Dob 503 Boston MA 02118 |
| Practice Telephone | 6176386525 |
| Practice Fax Number | 6176387448 |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2014-04-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
RN2259252 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110091798A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265890909 | Kathleen Sullivan | Clinical Nurse Specialist | 2040 9th Ave, # C, Honolulu, HI 96816-2952 | 2016-02-09 |
| 1871907006 | Kathleen E Sullivan | Behavioral Analyst | 118 35th St, Bellingham, WA 98225-6053 | 2014-06-16 |
| 1285057687 | Kathleen Sullivan | Registered Nurse | 2380 Timbercrest Cir W, Clearwater, FL 33763-1624 | 2014-01-22 |
| 1538436555 | Kathleen Sullivan | Speech-Language Pathologist | 301 Charlotte Ave, Hamburg, NY 14075-3857 | 2011-11-18 |
| 1396023388 | Kathleen T Sullivan | Occupational Therapist | 6678 County Road 32, Norwich, NY 13815-3554 | 2011-07-26 |
| 1912204322 | Kathleen Ann Sullivan | Speech-Language Pathologist | 3043 State Route 48, Oswego, NY 13126-5733 | 2011-02-21 |
| 1790938694 | Kathleen Scarlett Sullivan | Marriage & Family Therapist | 3851 Rosecrans St Ste K-08, San Diego, CA 92110-3115 | 2008-10-23 |
| 1639320336 | Kathleen Connelly Sullivan | Physician Assistant | 2 Fogg Rd, Weymouth, MA 02190 | 2008-10-01 |
| 1306095955 | Kathleen M. Sullivan | Nurse Practitioner | 20511 Sunset Ln, Lago Vista, TX 78645-6245 | 2008-09-18 |
| 1356518492 | Kathleen C Sullivan | Licensed Practical Nurse | 340 Vincent St., Syracuse, NY 13210-3712 | 2008-05-08 |
| Street Address |
830 HARRISON AVE MOAKLEY, 2ND FLOOR |
| City | BOSTON |
| State | MA |
| Zip Code | 02118-2905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316937436 | Minh Tam Truong | Radiology | 830 Harrison Ave, Moakley Building Ll100, Boston, MA 02118 | 2005-10-28 |
| 1457950131 | Maggie Ruderman | Genetic Counselor, MS | 830 Harrison Ave, Boston, MA 02118-2905 | 2020-10-22 |
| 1760096606 | Fabio Petrocca | Student in an Organized Health Care Education/Training Program | 830 Harrison Ave, Boston, MA 02118-2905 | 2020-09-08 |
| 1801447495 | Kailey Vitale | Speech-Language Pathologist | 830 Harrison Ave, Boston, MA 02118-2905 | 2019-09-25 |
| 1437718228 | Kayla Mcdonald | Physician Assistant | 830 Harrison Ave, Moakley, Suite 3400, Boston, MA 02118 | 2019-06-06 |
| 1154984888 | Elizabeth Tiani | Nurse Practitioner | 830 Harrison Ave, Boston, MA 02118 | 2019-04-18 |
| 1669938981 | Lynsie Rae Adams | Nurse Practitioner | 830 Harrison Ave, Moakley, 3rd Floor, Boston, MA 02118 | 2019-02-11 |
| 1548754385 | Lisa Jiyoung Kim | Nurse Practitioner | 830 Harrison Ave, Moakley, 3rd Floor, Boston, MA 02118 | 2018-06-15 |
| 1891226650 | Navid Alavi | Internal Medicine | 830 Harrison Ave, Moakley, 3rd Floor, Boston, MA 02118 | 2017-03-23 |
| 1952842189 | Samuel Rubin | Otolaryngology | 830 Harrison Ave, 1st Floor, Boston, MA 02118-2905 | 2017-03-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649870023 | Carlos E Salazar | Counselor | Hcrc 23 Bradston St., Boston, MA 02118 | 2020-10-27 |
| 1780292607 | Jinal Gandhi | Student in an Organized Health Care Education/Training Program | Shapiro Primary Care, 725 Albany Street, Boston, MA 02118 | 2020-07-16 |
| 1669094777 | German Eduardo Velez | Student in an Organized Health Care Education/Training Program | One Boston Medical Center Place Boston Medical Center, Boston, MA 02118 | 2020-05-12 |
| 1255969895 | Isabela Medeiros Heringer Pereira | Student in an Organized Health Care Education/Training Program | 670 Albany Stree, 4th Floor, Boston, MA 02118 | 2020-03-30 |
| 1033746466 | Karan Sunil Hingorani | Student in an Organized Health Care Education/Training Program | Shapiro Primary Care, 725 Albany Street, Precepting Room, Boston, MA 02118 | 2020-03-25 |
| 1326672791 | Azza Ahmed | Dentist | 635 Albany St. G-744, Boston, MA 02118 | 2020-02-25 |
| 1538707401 | Jane Margolis | Social Worker | 840 Harrison Ave., Dowling 2 South, Boston, MA 02118 | 2019-12-11 |
| 1871134833 | Supontep Teerakanok | Dentist | Henry Goldman School of Dental Medicine, 635 Albany St, Boston, MA 02118 | 2019-10-01 |
| 1750939583 | Qasim Silman Ajmi | Orthopaedic Surgery | Department of Orthopaedic Surgery Boston Medical Center, 850 Harrison Ave Dowling 2 North, Boston, MA 02118 | 2019-08-26 |
| 1922655539 | Jami Ryan Pollard | Physician Assistant | 840 Harrison Avenue, Menino Building, Boston, MA 02118 | 2019-08-20 |
| Find all providers in zip 02118 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649877705 | Stacey Rose Tosado | Nurse Practitioner | 108 Myrtle St Apt 3, Boston, MA 02114-4348 | 2020-10-02 |
| 1881230027 | Linda Marie Sabo | Nurse Practitioner | 300 Pier 4 Blvd Unit 4j, Boston, MA 02210-2644 | 2019-11-22 |
| 1417479940 | Sarah Jane Georgia | Nurse Practitioner | 165 Cambridge St Ste 301, Boston, MA 02114-2751 | 2017-07-17 |
| 1932597499 | Sheila Brown | Nurse Practitioner | 218 Humboldt Avenue, Boston, MA 02121 | 2015-01-06 |
| 1871902635 | Lindsy Mary Gusiora | Nurse Practitioner | 1 Brookline Ave Ste 105, Boston, MA 02215-3421 | 2014-08-06 |
| 1710308218 | Kristin Fleischmann-rose | Nurse Practitioner | 330 Brookline Ave Fl 5, Breastcare Center, Boston, MA 02215-5400 | 2013-12-31 |
| 1033546700 | Haidang Truong Kelly | Nurse Practitioner | 147 Milk St Fl 3, Boston, MA 02109 | 2013-09-26 |
| 1659620821 | Darlene Electa Sawicki | Nurse Practitioner | 55 Fruit Street, Bigelow 1256, Massachusetts General Hospital, Boston, MA 02114 | 2012-09-04 |
| 1710258371 | Megan Leahy Grady | Nurse Practitioner | 165 Cambridge St., Charles River Plaza 5th Floor Mgh Senior Health, Boston, MA 02114 | 2012-01-13 |
| 1568739480 | Ariel Leora Watriss | Nurse Practitioner | 1340 Boylston St Fl 8, Boston, MA 02215-4302 | 2011-11-21 |
| Find all providers in BOSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.