Provider Demographics
NPI:1487600276
Name:SULLIVAN, LYNN C (FNP)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:C
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:C
Other - Last Name:BREDDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:P O BOX 4749
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0227
Mailing Address - Country:US
Mailing Address - Phone:541-789-7000
Mailing Address - Fax:541-618-4413
Practice Address - Street 1:2825 EAST BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8332
Practice Address - Country:US
Practice Address - Phone:541-789-7000
Practice Address - Fax:541-618-4413
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227698Medicaid
OR227698Medicaid