Healthcare Provider Details

I. General information

NPI: 1225123581
Provider Name (Legal Business Name): ELIZABETH A. MAFFIE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH A. MASON N.P.

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 MORTON ST
MATTAPAN MA
02126-2834
US

IV. Provider business mailing address

85 MORTON ST
CANTON MA
02021-1526
US

V. Phone/Fax

Practice location:
  • Phone: 617-533-2400
  • Fax: 617-533-2478
Mailing address:
  • Phone: 781-828-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number194529
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: