Healthcare Provider Details

I. General information

NPI: 1518898899
Provider Name (Legal Business Name): ELISABETH ANNE BONOCORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

663 E 7TH ST APT 3
SOUTH BOSTON MA
02127-5491
US

V. Phone/Fax

Practice location:
  • Phone: 617-736-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2378883
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: