Basic Information
| Provider Information | |||||||||
| NPI: | 1558316380 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DEOLIVEIRA | ||||||||
| FirstName: | ELZIRA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PCNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 298 HOWARD STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017028313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088792250 | ||||||||
| FaxNumber: | 5086202637 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 SPRUCE STREET | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014533361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009775555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 186008 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | RN186008 | 01 | MA | BOARD OF REGISTRATION IN NURSING | OTHER |