Provider Demographics
NPI:1609122431
Name:BURCH, ELIZABETH SARAH (CPNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SARAH
Last Name:BURCH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SARAH
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:51 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-5501
Mailing Address - Country:US
Mailing Address - Phone:508-735-1505
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301770363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics