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General NPI Number Information
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NPI Number | 1124824420
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Entity Type | Individual
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Provider Name | ELISA GAO FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 24 NEWTON ST
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City | SOUTHBOROUGH
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State | MA
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Zip | 01772-1215
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Country | US
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Telephone | 508-460-3250
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Fax | 508-453-8152
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Provider Business Mailing Address
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Address Line | 5 NEPONSET ST ATTN:MEDICAL STAFF SERVICES
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City | WORCESTER
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State | MA
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Zip | 01606-2714
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Country | US
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Telephone | 508-852-0600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2362747
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2362747
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License Number State | MA
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