| NPI | 1710682422 |
|---|---|
| Former Name | SHAVON SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2300960) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2300960) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-04-03 |