Healthcare Provider Details

I. General information

NPI: 1205494630
Provider Name (Legal Business Name): ELIZABETH M MORAN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 WASHINGTON ST
DORCHESTER MA
02124-3510
US

IV. Provider business mailing address

637 WASHINGTON ST
DORCHESTER MA
02124-3510
US

V. Phone/Fax

Practice location:
  • Phone: 617-825-9660
  • Fax: 617-288-7898
Mailing address:
  • Phone: 617-825-9660
  • Fax: 617-288-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2326091
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: