Healthcare Provider Details

I. General information

NPI: 1104804392
Provider Name (Legal Business Name): AIMEE M STEFANSKI MS, APRN, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 WAWECUS ST SUITE 106
NORWICH CT
06360-2160
US

IV. Provider business mailing address

79 WAWECUS ST SUITE 106
NORWICH CT
06360-2160
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-2679
  • Fax: 860-889-2862
Mailing address:
  • Phone: 860-886-2679
  • Fax: 860-889-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberE61345
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003278
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: