Provider Demographics
NPI:1558316380
Name:DEOLIVEIRA, ELZIRA A (PCNS)
Entity Type:Individual
Prefix:
First Name:ELZIRA
Middle Name:A
Last Name:DEOLIVEIRA
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 HOWARD STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8313
Mailing Address - Country:US
Mailing Address - Phone:508-879-2250
Mailing Address - Fax:508-620-2637
Practice Address - Street 1:40 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3361
Practice Address - Country:US
Practice Address - Phone:800-977-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186008364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN186008OtherBOARD OF REGISTRATION IN NURSING
MARN186008OtherBOARD OF REGISTRATION IN NURSING