Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2299781 | MA |
NPI | 1346616182 |
---|---|
Provider Name | Elyssa Rene Fitelson |
First Address | Billerica, MA 01821-2314 |
Second Address | Boston, MA 02114-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2015 |
Last Update Date | 17/08/2015 |