Provider Demographics
NPI:1740805829
Name:MACNEIL, ELIZABETH KELSEY (CNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KELSEY
Last Name:MACNEIL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ALDRICH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2750
Mailing Address - Country:US
Mailing Address - Phone:857-366-1268
Mailing Address - Fax:
Practice Address - Street 1:185 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-632-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner