Healthcare Provider Details

I. General information

NPI: 1225612310
Provider Name (Legal Business Name): ELIZABETH GAUDET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EMBANKMENT ST
LAWRENCE MA
01841-4731
US

IV. Provider business mailing address

10 EMBANKMENT ST
LAWRENCE MA
01841-4731
US

V. Phone/Fax

Practice location:
  • Phone: 978-687-6300
  • Fax: 978-975-4197
Mailing address:
  • Phone: 978-687-6300
  • Fax: 978-975-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2259361
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: