Healthcare Provider Details

I. General information

NPI: 1265978886
Provider Name (Legal Business Name): STEPHANIE PONTE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 TURNPIKE ST STE 25
NORTH ANDOVER MA
01845-5937
US

IV. Provider business mailing address

575 TURNPIKE ST STE 25
NORTH ANDOVER MA
01845-5937
US

V. Phone/Fax

Practice location:
  • Phone: 978-290-4646
  • Fax: 978-290-4822
Mailing address:
  • Phone: 978-290-4646
  • Fax: 978-290-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2269271
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: