# ELISE MARIAM SAGE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1598048878
- **Gender:** F
- **Credential:** PNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 10.107616 | CT | — |
| 363LP0200X | Pediatric Nurse Practitioner | 005079 | CT | — |
| 363LP0200X | Pediatric Nurse Practitioner | 12.005079 | CT | Yes |
| 363LP0200X | Pediatric Nurse Practitioner | 2268080 | MA | — |

## Other

- **Enumeration date:** 09/23/2011
- **Last updated:** 07/30/2015