Provider Demographics
NPI:1225029622
Name:CRICHFIELD, ELISE J (ANP)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:J
Last Name:CRICHFIELD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 CHIEF JUSTICE CUSHING HWY
Mailing Address - Street 2:STE 301
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1391
Mailing Address - Country:US
Mailing Address - Phone:781-383-6261
Mailing Address - Fax:781-383-1084
Practice Address - Street 1:223 CHIEF JUSTICE CUSHING HWY
Practice Address - Street 2:STE 301
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1391
Practice Address - Country:US
Practice Address - Phone:781-383-6261
Practice Address - Fax:781-383-1084
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213324363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0352080Medicaid
MANP2514OtherBCBS
P09475Medicare UPIN
MA0352080Medicaid