Provider Demographics
NPI:1659814895
Name:NIGHTINGALE, ELIZABETH CLARK (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CLARK
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 HERRING WEIR RD
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3316
Mailing Address - Country:US
Mailing Address - Phone:781-929-1027
Mailing Address - Fax:
Practice Address - Street 1:46 HERRING WEIR RD
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3316
Practice Address - Country:US
Practice Address - Phone:781-929-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291218163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse