Healthcare Provider Details

I. General information

NPI: 1396383790
Provider Name (Legal Business Name): STEPHANIE LYNN MEJIAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HARTFORD HEALTHCARE-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-3342
  • Fax: 860-545-1675
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8651
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: