Provider Demographics
NPI:1679698104
Name:NILSSON, ELIZABETH M (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:NILSSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1714
Practice Address - Country:US
Practice Address - Phone:207-797-8881
Practice Address - Fax:207-797-5093
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER019940367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8315Medicare ID - Type UnspecifiedMEDICARE