Provider Demographics
NPI:1700686888
Name:CHADWICK, ELYSIA (RN, LMT)
Entity type:Individual
Prefix:
First Name:ELYSIA
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 THOMAS LEIGHTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2234
Mailing Address - Country:US
Mailing Address - Phone:401-457-6375
Mailing Address - Fax:
Practice Address - Street 1:2145 DIAMOND HILL RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-5135
Practice Address - Country:US
Practice Address - Phone:401-457-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN37437163WM1400X
RIMT02896163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Multi-Specialty