Healthcare Provider Details

I. General information

NPI: 1346616182
Provider Name (Legal Business Name): ELYSSA RENE FITELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST LUNDER 6
BOSTON MA
02114-2621
US

IV. Provider business mailing address

7 ROSEWOOD AVE
BILLERICA MA
01821-2314
US

V. Phone/Fax

Practice location:
  • Phone: 857-238-5600
  • Fax:
Mailing address:
  • Phone: 202-271-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number2299781
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: