Healthcare Provider Details

I. General information

NPI: 1225029622
Provider Name (Legal Business Name): ELISE J CRICHFIELD ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 CHIEF JUSTICE CUSHING HWY STE 301
COHASSET MA
02025-1391
US

IV. Provider business mailing address

223 CHIEF JUSTICE CUSHING HWY STE 301
COHASSET MA
02025-1391
US

V. Phone/Fax

Practice location:
  • Phone: 781-383-6261
  • Fax: 781-383-1084
Mailing address:
  • Phone: 781-383-6261
  • Fax: 781-383-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number213324
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: