Provider Demographics
NPI:1306865829
Name:BARTLETT, ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:300 CANAL ST
Mailing Address - Street 2:MINUTE CLINIC
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4558
Mailing Address - Country:US
Mailing Address - Phone:781-507-3077
Mailing Address - Fax:
Practice Address - Street 1:300 CANAL ST
Practice Address - Street 2:MINUTE CLINIC
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4558
Practice Address - Country:US
Practice Address - Phone:781-507-3077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18229363LF0000X
MA145412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ44992Medicare UPIN
MANP5036Medicare ID - Type Unspecified