Healthcare Provider Details

I. General information

NPI: 1982909313
Provider Name (Legal Business Name): ELISABETH R WARNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2011
Last Update Date: 01/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HEARTBREAK RD UNIT 3
IPSWICH MA
01938-2584
US

IV. Provider business mailing address

35 HEARTBREAK RD UNIT 3
IPSWICH MA
01938-2584
US

V. Phone/Fax

Practice location:
  • Phone: 978-535-6043
  • Fax: 978-535-6047
Mailing address:
  • Phone: 978-535-6043
  • Fax: 978-535-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN215569
License Number StateMA

VIII. Authorized Official

Name: ANN MARIE MCGRANE
Title or Position: OFFICE MANAGER
Credential:
Phone: 978-535-6043