Provider Demographics
NPI:1487958666
Name:MENDES, ELIZABETH MACEDO (LPN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MACEDO
Last Name:MENDES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MACEDO
Other - Last Name:TEIXEIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:43 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-2823
Mailing Address - Country:US
Mailing Address - Phone:508-974-5041
Mailing Address - Fax:
Practice Address - Street 1:190 LENOX ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3416
Practice Address - Country:US
Practice Address - Phone:781-234-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58699385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1780791467Medicaid
MA1780791467Medicare Oscar/Certification
MA1780791467Medicaid
MA1780791467Medicare PIN
MA1780791467Medicare NSC