Healthcare Provider Details

I. General information

NPI: 1396258489
Provider Name (Legal Business Name): ELIZABETH JOY SHITEMI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH JOY CROSBY RN

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MARKET SQ
LYNN MA
01905-2420
US

IV. Provider business mailing address

12 GRANT RD
NEWMARKET NH
03857-2101
US

V. Phone/Fax

Practice location:
  • Phone: 603-205-3577
  • Fax:
Mailing address:
  • Phone: 603-205-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN277235
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: