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General NPI Number Information
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NPI Number | 1174674261
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Entity Type | Individual
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Provider Name | MARGARET MOSS ELLISON APRN, BC
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Gender | Female
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 950 WINTER ST SUITE 3800
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City | WALTHAM
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State | MA
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Zip | 02451-1424
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Country | US
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Telephone | 781-472-8592
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Fax |
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Provider Business Mailing Address
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Address Line | 950 WINTER ST SUITE 3800
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City | WALTHAM
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State | MA
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Zip | 02451-1424
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Country | US
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Telephone | 781-801-3897
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 216415
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License Number State | MA
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