Provider Demographics
NPI:1215664503
Name:CUNHA-AFONSO, ELISANGELA MENDES (RN, BSN)
Entity type:Individual
Prefix:
First Name:ELISANGELA
Middle Name:MENDES
Last Name:CUNHA-AFONSO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2903
Mailing Address - Country:US
Mailing Address - Phone:508-840-2678
Mailing Address - Fax:
Practice Address - Street 1:69 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2903
Practice Address - Country:US
Practice Address - Phone:508-840-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty