Provider Demographics
NPI:1003459371
Name:KUDZMA, ELIZABETH CONNELLY (DNSC MPH WHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CONNELLY
Last Name:KUDZMA
Suffix:
Gender:F
Credentials:DNSC MPH WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-1775
Mailing Address - Country:US
Mailing Address - Phone:781-837-1095
Mailing Address - Fax:
Practice Address - Street 1:514 HOLLY RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-1775
Practice Address - Country:US
Practice Address - Phone:781-837-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA96723363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health