Provider Demographics
NPI:1235490665
Name:NEIL, ELIZABETH DURKEE (MAOM)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DURKEE
Last Name:NEIL
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:DURKEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1824
Mailing Address - Country:US
Mailing Address - Phone:774-213-5513
Mailing Address - Fax:
Practice Address - Street 1:16 WOODVIEW DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1824
Practice Address - Country:US
Practice Address - Phone:774-213-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253515171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist