Healthcare Provider Details

I. General information

NPI: 1275464158
Provider Name (Legal Business Name): ELSIE JEAN MICHEL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 COMMON ST
LAWRENCE MA
01840-1116
US

IV. Provider business mailing address

414 COMMON ST
LAWRENCE MA
01840-1116
US

V. Phone/Fax

Practice location:
  • Phone: 857-452-4481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN244207
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: