Provider Demographics
NPI:1851303754
Name:GAWLOCKI, ELLEN JANE (APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:JANE
Last Name:GAWLOCKI
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 FARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2009
Mailing Address - Country:US
Mailing Address - Phone:978-356-9370
Mailing Address - Fax:978-532-6366
Practice Address - Street 1:3 ESSEX GREEN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2927
Practice Address - Country:US
Practice Address - Phone:978-356-3826
Practice Address - Fax:978-532-6366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0556Medicare ID - Type Unspecified