NANCI JACQULYN SULLIVAN-BLACKERT (NPI# 1568718336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1568718336 |
Entity Type | Individual |
Full Name | NANCI JACQULYN SULLIVAN-BLACKERT |
Other Name | NANCI SULLIVAN BLACKERT |
Credential | RN, MSN, CDE, NP-C |
Practice Address |
3604 Bush St Raleigh NC 27609-7511 |
Practice Telephone | 9198767807 |
Practice Fax Number | 9194598402 |
Mailing Telephone | 9198767807 |
Mailing Fax Number | 9194598402 |
Enumeration Date | 2012-07-31 |
Last Update Date | 2016-08-11 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
5005832 | NC | Physician Assistants & Advanced Practice Nursing Providers |
N | 363LF0000X |
Nurse Practitioner Specialization: Family |
F0512372 | NC | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
HNFS/TRICARE | 1568718336 | 01 | |
NC | FIRST CAROLINA CARE, INC | FH4001480 | 01 |
NC | FIRST MEDICARE DIRECT | FH4001480 | 01 |
NC | 1568718336 | 05 |
Street Address |
3604 BUSH ST |
City | RALEIGH |
State | NC |
Zip Code | 27609-7511 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891797049 | Wake Nephrology Associates, P.a. | Specialist | 3604 Bush St, Raleigh, NC 27609-7511 | 2005-06-01 |
1770901993 | Sarah Mistrot | Physician Assistant | 3604 Bush St, Raleigh, NC 27609-7511 | 2014-04-03 |
1508299777 | Shannon Joan Clark | Nurse Practitioner | 3604 Bush St, Raleigh, NC 27609-7511 | 2013-08-12 |
1699069948 | Robert Edward Olivo | Internal Medicine | 3604 Bush St, Raleigh, NC 27609-7511 | 2011-06-03 |
1679885107 | Lori Michelle Haskins | Nurse Practitioner | 3604 Bush St, Raleigh, NC 27609-7511 | 2010-07-13 |
1376602391 | Deborah B Berg | Dietitian, Registered | 3604 Bush St, Raleigh, NC 27609-7511 | 2006-12-06 |
1780796508 | Bio-medical Applications of North Carolina, Inc. | Clinic/Center | 3604 Bush St, Raleigh, NC 27609-7511 | 2006-08-31 |
1386752228 | Jacqueline Suzanne Sebastian | Nurse Practitioner | 3604 Bush St, Raleigh, NC 27609-7511 | 2006-08-29 |
1366470791 | Donna Antonia Theodore | Physician Assistant | 3604 Bush St, Raleigh, NC 27609-7511 | 2006-06-28 |
1689612442 | Jessica J Oneill | Physician Assistant | 3604 Bush St, Raleigh, NC 27609-7511 | 2006-06-03 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184235582 | Choice Service Solutions LLC | In Home Supportive Care | 5300 Six Fox Rd Siite205, Raleigh, NC 27609 | 2020-08-11 |
1003426073 | Rosana Oba -rovira | Registered Nurse | 5300 Six Fox Road, Suite 205, Raleigh, NC 27609 | 2020-08-05 |
1821612706 | Helen Alexandra Bonner | Physical Medicine & Rehabilitation | Hey Clinic Pa, 3320 Wake Forest Road Ste 450, Raleigh, NC 27609 | 2020-06-05 |
1215423579 | Appiah Nana Larbi | Social Worker | Easter Seals Ucp 4000 Wake Forest Rd Ste 200, Raleigh, NC 27609 | 2018-07-10 |
1215423777 | Broadway Home Care LLC | In Home Supportive Care | 107 Windel Dr Ste 105, Raleigh, NC 27609 | 2018-07-09 |
1275027948 | Lacey Allene Cottingham | Social Worker | 312 W Millbrook Rd Ste 129, Raleigh, NC 27609 | 2018-06-18 |
1447748819 | Integrated Dermatology of North Raleigh, Pllc | Dermatology | 3809 Computer Dr Ste 200, Raleigh, NC 27609 | 2018-05-01 |
1902325418 | Naomi Christine Askew | Nurse Practitioner | 3400 Wake Forest Drive, Bldg 9, Bldg #9, 4th Floor, Raleigh, NC 27609 | 2017-09-15 |
1962929679 | Alexia Montague | Social Worker | 1306 Paddock Drive Suite E-100, Raleigh, NC 27609 | 2017-08-23 |
1730602236 | Chantel Washington-mbuthia | Counselor | 1100 Logger Ct. Ste C100, Heartfelt Alternative Inc, Raleigh, NC 27609 | 2017-07-18 |
Find all providers in zip 27609 |
Taxonomy Code | 363LF0000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Family |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417558990 | Munira Amirali Ward | Nurse Practitioner | 2617 Valley Haven Dr, Raleigh, NC 27603-3197 | 2020-11-03 |
1710598644 | Nicole Dora Licato | Nurse Practitioner | 7200 Creedmoor Rd Ste 208, Raleigh, NC 27613-1711 | 2020-08-13 |
1316561178 | Mintoria Lynette Stockton | Nurse Practitioner | 8332 Mcguire Dr, Raleigh, NC 27616-5682 | 2020-06-07 |
1700407103 | Sadonna Marlene Sawyer | Nurse Practitioner | 3311 Grove Crabtree Cres Apt 122, Raleigh, NC 27613-3063 | 2020-04-27 |
1447879903 | Christapher Frank | Nurse Practitioner | 2034 Wesvill Court, Suite 320, Raleigh, NC 28326 | 2020-04-14 |
1265065015 | Shubham Tyagi | Nurse Practitioner | Duke Urgent Care Brier Creek, 10211 Alm Street Suite 1200, Raleigh, NC 27617-2761 | 2020-02-20 |
1073163812 | Taylor Brooke Lawrence | Nurse Practitioner | 10208 Cerny St Ste 301, Raleigh, NC 27617-1000 | 2019-09-13 |
1811456320 | Elizabeth Campbell Mcgrath | Nurse Practitioner | 2615 Lake Dr Ste 201, Raleigh, NC 27607-6694 | 2019-03-14 |
1922578541 | Dorothy Nwizu | Nurse Practitioner | 608 Kavkaz St, Raleigh, NC 27610-3176 | 2018-11-26 |
1265900013 | Patricia-marie Edge Odom | Nurse Practitioner | 3000 New Bern Ave Ste G100, Raleigh, NC 27610-1231 | 2018-11-09 |
Find all providers in RALEIGH |
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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.