Healthcare Provider Details

I. General information

NPI: 1629120407
Provider Name (Legal Business Name): ELLEN CREAMER SITRON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN MARGARET CREAMER APN

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 PROFESSORS ROW TUFTS UNIVERSITY HEALTH SERVICES
MEDFORD MA
02155
US

IV. Provider business mailing address

14 WOODBURY ST
GLOUCESTER MA
01930-1038
US

V. Phone/Fax

Practice location:
  • Phone: 617-625-3350
  • Fax:
Mailing address:
  • Phone: 978-281-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number148284
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: