Provider Demographics
NPI:1053930602
Name:POWERS, ELIZABETH RENEE (AGPCNP-BC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:RENEE
Last Name:POWERS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4700
Mailing Address - Country:US
Mailing Address - Phone:617-823-1834
Mailing Address - Fax:
Practice Address - Street 1:965 ELM STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-405-6100
Practice Address - Fax:978-287-5169
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216555363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053930602OtherNPI
MA216555Medicaid
MA216555OtherNURSING LICENSE