Provider Demographics
NPI:1255754644
Name:PLANTE, ELYSE (NP)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:PLANTE
Suffix:
Gender:F
Credentials:NP
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Other - Middle Name:
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Mailing Address - Street 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1465
Practice Address - Country:US
Practice Address - Phone:508-350-2300
Practice Address - Fax:508-350-2309
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN265193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1255754644OtherBLUE CROSS & BLUE SHEILD OF MASS
MA110098777AMedicaid
MAS400159223OtherMEDICARE