Provider Demographics
NPI:1255808986
Name:WAITHIRA, ELIZABETH S (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:WAITHIRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:84 EMILY JEFFERS ROAD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:508-933-9665
Mailing Address - Fax:
Practice Address - Street 1:NOVA PSYCHIATRIC SERVICES
Practice Address - Street 2:1261 FURNACE BROOK PARKWAY
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-479-4545
Practice Address - Fax:617-479-4545
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2274050363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology