Provider Demographics
NPI:1245419035
Name:RIEDL, ELZA (NP)
Entity Type:Individual
Prefix:
First Name:ELZA
Middle Name:
Last Name:RIEDL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111GROSSMAN DRVIE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-849-2300
Mailing Address - Fax:781-849-2314
Practice Address - Street 1:111GROSSMAN DRVIE
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-849-2300
Practice Address - Fax:781-849-2314
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner