1053930602 NPI number — MS. ELIZABETH RENEE POWERS AGPCNP-BC

Table of content: MS. ELIZABETH RENEE POWERS AGPCNP-BC (NPI 1053930602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053930602 NPI number — MS. ELIZABETH RENEE POWERS AGPCNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWERS
Provider First Name:
ELIZABETH
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
AGPCNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053930602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CHERRY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01545-4700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-823-1834
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
965 ELM STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-405-6100
Provider Business Practice Location Address Fax Number:
978-287-5169
Provider Enumeration Date:
04/14/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  216555 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053930602 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 216555 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 216555 . This is a "NURSING LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".