Healthcare Provider Details

I. General information

NPI: 1508362633
Provider Name (Legal Business Name): STEPHANIE HEALY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GARLAND ST
EVERETT MA
02149-5066
US

IV. Provider business mailing address

179 CAMPBELL AVE
REVERE MA
02151-3552
US

V. Phone/Fax

Practice location:
  • Phone: 617-389-6270
  • Fax:
Mailing address:
  • Phone: 781-656-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2276967
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: