Provider Demographics
NPI:1023079373
Name:ELIE, CATHERINE D (FNP)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:D
Last Name:ELIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2067
Mailing Address - Country:US
Mailing Address - Phone:978-323-2819
Mailing Address - Fax:978-323-2820
Practice Address - Street 1:1574 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2067
Practice Address - Country:US
Practice Address - Phone:978-323-2819
Practice Address - Fax:978-323-2820
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15184OtherBCBSMA NUMBER
MANP2055Medicare ID - Type UnspecifiedMEDICARE PROVIDRE NUMBER