Healthcare Provider Details

I. General information

NPI: 1407170921
Provider Name (Legal Business Name): ELIZABETH ROSE LEMCKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 OAK DR
ORANGE MA
01364-9202
US

IV. Provider business mailing address

61 OAK DR
ORANGE MA
01364-9202
US

V. Phone/Fax

Practice location:
  • Phone: 413-242-8141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2311521
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: