Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN2336960 | MA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN02472 | RI |
NPI | 1326645300 |
---|---|
Provider Name | Elizabeth Catherine Stefanilo |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2020 |
Last Update Date | 15/11/2021 |