Healthcare Provider Details

I. General information

NPI: 1316560907
Provider Name (Legal Business Name): ELIZABETH CILIA FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

204 ARSENAL ST APT 491
WATERTOWN MA
02472-3092
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3940
  • Fax:
Mailing address:
  • Phone: 617-543-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2336546
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2336546
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: