Provider Demographics
NPI: | 1003590365 |
---|---|
Name: | ELEV8 HEALTH & WELLNESS |
Entity Type: | Organization |
Organization Name: | ELEV8 HEALTH & WELLNESS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | FNP |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ELIZABETH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DA SILVA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | APRN |
Authorized Official - Phone: | 401-258-2579 |
Mailing Address - Street 1: | 115 COLUMBUS AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PAWTUCKET |
Mailing Address - State: | RI |
Mailing Address - Zip Code: | 02860-5550 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 401-258-2579 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1243 MINERAL SPRING AVE UNIT 7 |
Practice Address - Street 2: | |
Practice Address - City: | NORTH PROVIDENCE |
Practice Address - State: | RI |
Practice Address - Zip Code: | 02904-4636 |
Practice Address - Country: | US |
Practice Address - Phone: | 401-258-2579 |
Practice Address - Fax: | 401-340-1831 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-06-14 |
Last Update Date: | 2023-06-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |