Provider Demographics
NPI:1831446970
Name:O'REILLY, ELIZABETH ANN
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:O'REILLY
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP MSN, MPH
Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:BREAST ONCOLOGY SUITE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:781-325-6295
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:BREAST ONCOLOGY SUITE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:781-325-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN176619363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health