Provider Demographics
NPI:1932101862
Name:ELLIOTT, MARY RACHEL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RACHEL
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:723 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2142
Mailing Address - Country:US
Mailing Address - Phone:410-228-3294
Mailing Address - Fax:410-228-8976
Practice Address - Street 1:503 MUIR ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1848
Practice Address - Country:US
Practice Address - Phone:410-228-3294
Practice Address - Fax:410-228-8976
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR057515363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology