Healthcare Provider Details

I. General information

NPI: 1487713947
Provider Name (Legal Business Name): STEPHANIE T LENNON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 KESSLER BOULEVARD EAST DR STE 110
INDIANAPOLIS IN
46220-2889
US

IV. Provider business mailing address

126 ALPINE DR
SANDY HOOK CT
06482-1254
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax: 203-720-6996
Mailing address:
  • Phone: 860-933-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number003468
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number003468
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: