| NPI | 1063733731 |
|---|---|
| Former Name | LAURA COLLEEN SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 225715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 255715) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2025-07-28 |