Provider Demographics
NPI:1710393640
Name:CHAN, ELAINE (RN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25 BOYLSTON ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1715
Mailing Address - Country:US
Mailing Address - Phone:617-244-6000
Mailing Address - Fax:617-232-9376
Practice Address - Street 1:25 BOYLSTON ST
Practice Address - Street 2:SUITE 112
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1715
Practice Address - Country:US
Practice Address - Phone:617-244-6000
Practice Address - Fax:617-232-9376
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY673761163WP0200X
NJ26NR17027600163WP0200X
MARN2297449163WP0200X, 363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care