Healthcare Provider Details

I. General information

NPI: 1225616634
Provider Name (Legal Business Name): STEPHANIE A WILLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE A BELLIVEAU

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, FLOOR 1
CONCORD NH
03301
US

IV. Provider business mailing address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, FLOOR 1
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3388
  • Fax: 603-227-7536
Mailing address:
  • Phone: 603-224-3388
  • Fax: 603-227-7536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number05950723
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number059507-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: