Healthcare Provider Details

I. General information

NPI: 1124016142
Provider Name (Legal Business Name): ELIZABETH MELVILLE KLEMENTS PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MELVILLE

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 PLEASANT ST BRIDGEWATER PEDIATRICS
BRIDGEWATER MA
02324
US

IV. Provider business mailing address

1029 PLEASANT ST BRIDGEWATER PEDIATRICS
BRIDGEWATER MA
02324
US

V. Phone/Fax

Practice location:
  • Phone: 508-697-8116
  • Fax: 508-697-8117
Mailing address:
  • Phone: 508-697-8116
  • Fax: 508-697-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number137478
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: