Provider Demographics
NPI:1467734194
Name:CHACKO, ELIZABETH M (CRNA, APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:CHACKO
Suffix:
Gender:F
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1450 CHAPEL ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-3538
Mailing Address - Fax:203-687-5461
Practice Address - Street 1:MASSACHUSETTS GENERAL BRIGHAM HOSPITAL
Practice Address - Street 2:81 HIGHLAND AVE, SALEM, MA
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-354-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2358660367500000X
CT4801367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered