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General NPI Number Information
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NPI Number | 1255697561
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Entity Type | Individual
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Provider Name | STEPHANIE BOISVERT CANAL PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | YOUTH ADVOCATE PROGRAMS, INC 1515 N FRONT STREET
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City | HARRISBURG
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State | PA
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Zip | 17102-1815
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Country | US
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Telephone | 717-232-3150
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Fax | 717-232-3127
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Provider Business Mailing Address
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Address Line | 520 WINDY WAY
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City | NEW CUMBERLAND
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State | PA
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Zip | 17070
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Country | US
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Telephone | 401-632-6670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN44775
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License Number State | RI
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