Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Elyse Lebeau Johnson, CNP

Individual provider Nurse Practitioner · NPI 1174166219

Elyse Lebeau Johnson, CNP is a Nurse Practitioner in Worcester, Massachusetts. Qualified in 2019, 7 years ago. Practices with Umass Memorial Medical Group Inc, a 2,467-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Massachusetts.

Years since qualifying
7
Licensed in
MA
In the registry since
2019
What do these letters mean?
CNP — Certified Nurse Practitioner
A certified nurse practitioner.

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Practice location Address checks out

55 Lake Ave N
Worcester, MA 01655-0002
Phone: (774) 443-7558
Fax: (774) 441-6086
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 119 Belmont St, Worcester, MA 01605-2903 — (774) 443-7552

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence RN2298507 (MA)

Record details

NPI number1174166219
Entity typeIndividual (Type 1)
GenderFemale
Credentials CNP
Sole proprietorNo
NPI enumeratedOctober 22, 2019
Last updated in NPPESOctober 29, 2020
Certification dateOctober 29, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Umass Memorial Medical Group Inc — 2467 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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