Provider Demographics
NPI:1457130643
Name:MCDONNELL, ELIZABETH MARY (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:COSMETOLOGIST
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Other - Credentials:
Mailing Address - Street 1:1175 MAIN ST STE 9
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1130
Mailing Address - Country:US
Mailing Address - Phone:978-733-1126
Mailing Address - Fax:
Practice Address - Street 1:1175 MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1130
Practice Address - Country:US
Practice Address - Phone:978-733-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier