Healthcare Provider Details

I. General information

NPI: 1427113638
Provider Name (Legal Business Name): ELIZABETH IRENE MALVEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CENTRAL ST CAMBRIDGE HEALTH ALLIANCE
SOMERVILLE MA
02143-2827
US

IV. Provider business mailing address

16 WALNUT ST
WAKEFIELD MA
01880-2727
US

V. Phone/Fax

Practice location:
  • Phone: 617-591-6127
  • Fax:
Mailing address:
  • Phone: 781-224-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN145904
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number145904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: