Elisabeth Ann Fuller-Haskell, NP
Individual provider Active NPI Adult Health Nurse Practitioner · Harwich, MA
NPI 1366525545 · NPPES record last updated Jan 8, 2008
Key facts
- NPI
- 1366525545
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 160499 (MA)
- Practice address
- 253 Pleasant Lake Ave
Harwich, MA 02645-2535 - Phone
- (508) 432-5233
- Fax
- (508) 430-0511
- NPI assigned
- Oct 23, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Pleasant Lake Medical Center LLC
Practice addresses (Care Compare)
253 Pleasant Lake Ave
Suite 100
Harwich, MA 02645-2552
Phone (617) 785-2066
Hospital & facility affiliations
- Cape Cod Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040317000654 | MA | Practitioner - Nurse Practitioner | 2264322981 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160499 | MA | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pleasant Lake Medical Center LLC | Current |
Accepting new patients |
Locations
253 Pleasant Lake Ave
Harwich, MA 02645
Phone (508) 432-5233
253 Pleasant Lake Ave
Ste 100
Harwich, MA 02645
Phone (508) 432-5233
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 160499 | MA | Yes |
| Gerontology Nurse Practitioner | 363LG0600X | 160499 | MA |
Addresses
Primary practice location
253 Pleasant Lake Ave
Harwich, MA 02645-2535
Mailing address
253 Pleasant Lake Ave
Harwich, MA 02645-2535
Phone (508) 432-5233
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP0055 | Other | BCBS | |
| NP 0055 | Other | MA | BCBS |
| UX3415 | Other | PTAN | |
| 0353761 | Medicaid | MA |
Other providers in Harwich, MA
- Epoch Senior Healthcare of Harwich, LLC
- Epoch SL VII Inc
- Nadine Gail Essency
- Ziad G Farah
- Taylor Flaherty
- Sarah Gibbons
- Ginger Care, Inc.
- Maria Gleason
- Nardia Gordon
- Kerrie A Greene
All providers in Harwich, MA · Adult Health Nurse Practitioner in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.