Provider Demographics
NPI:1912235318
Name:WASILEWSKI, ELISA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:MARIE
Last Name:WASILEWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:MARIE
Other - Last Name:CAPALDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 16149
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-0697
Mailing Address - Country:US
Mailing Address - Phone:401-453-9625
Mailing Address - Fax:401-435-7069
Practice Address - Street 1:195 COLLYER ST
Practice Address - Street 2:SUITE 302
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1869
Practice Address - Country:US
Practice Address - Phone:401-793-3236
Practice Address - Fax:401-793-5171
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00534363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical