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General NPI Number Information
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NPI Number | 1700169711
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Entity Type | Individual
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Provider Name | ELIZABETH BLACK SHORTSLEEVE NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 279 NORTH ST
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City | MEDFIELD
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State | MA
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Zip | 02052-1211
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Country | US
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Telephone | 401-258-2551
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Fax | 855-643-5020
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Provider Business Mailing Address
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Address Line | 475 KILVERT ST
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City | WARWICK
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State | RI
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Zip | 02886-1379
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Country | US
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Telephone | 401-258-2551
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Fax | 855-643-5020
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NPP37637
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2264330
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License Number State | MA
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