Healthcare Provider Details

I. General information

NPI: 1710393640
Provider Name (Legal Business Name): ELAINE CHAN FITZGERALD RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOYLSTON ST SUITE 112
CHESTNUT HILL MA
02467-1715
US

IV. Provider business mailing address

25 BOYLSTON ST STE 112
CHESTNUT HILL MA
02467-1710
US

V. Phone/Fax

Practice location:
  • Phone: 617-244-6000
  • Fax: 617-232-9376
Mailing address:
  • Phone: 617-244-6000
  • Fax: 617-232-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2297449
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2297449
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2297449
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: