Provider Demographics
NPI:1184692766
Name:MCCAFFERTY-OCONNELL, ELLEN M (NP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:MCCAFFERTY-OCONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:MCCAFFERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1250 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:617-774-0820
Mailing Address - Fax:617-774-0832
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0820
Practice Address - Fax:617-774-0832
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164362363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1768OtherBCBS
MANP1768OtherBCBS
NP1768Medicare ID - Type Unspecified