Healthcare Provider Details

I. General information

NPI: 1043382393
Provider Name (Legal Business Name): DONNA ANN STAMPONE N.P. M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SECOND AVE
WALTHAM MA
02451
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 781-487-3860
  • Fax: 781-487-3870
Mailing address:
  • Phone: 617-726-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number152711
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: