Healthcare Provider Details

I. General information

NPI: 1811138993
Provider Name (Legal Business Name): ELIZABETH ANNE RHODES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BOWDOIN ST
DORCHESTER MA
02122-1837
US

IV. Provider business mailing address

230 BOWDOIN ST
DORCHESTER MA
02122-1817
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-0100
  • Fax: 617-754-0220
Mailing address:
  • Phone: 617-754-0100
  • Fax: 617-754-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number134310
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: