Healthcare Provider Details

I. General information

NPI: 1265817712
Provider Name (Legal Business Name): MRS. ELIZABETH FABER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH WELCH CRNA

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 OAK STREET SE
SALEM MA
97301
US

IV. Provider business mailing address

35 JOSEPHINE AVE
SOMERVILLE MA
02144-2312
US

V. Phone/Fax

Practice location:
  • Phone: 508-561-5200
  • Fax:
Mailing address:
  • Phone: 617-899-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN282396
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: