Healthcare Provider Details

I. General information

NPI: 1497411821
Provider Name (Legal Business Name): STEPHANIE LYNN HORWATH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNN MCCOURT RN

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-4166
  • Fax:
Mailing address:
  • Phone: 860-972-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number169430
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number010969
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: