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General NPI Number Information
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NPI Number | 1770861007
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Entity Type | Individual
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Provider Name | EMILY KATHRYN STAGG APRN
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Gender | Female
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 71 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4131
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Country | US
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Telephone | 860-533-3494
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Fax |
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Provider Business Mailing Address
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Address Line | 98 LANCASTER RD
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City | GLASTONBURY
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State | CT
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Zip | 06033-1123
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Country | US
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Telephone | 203-314-9339
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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 | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 03277675
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 092976
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704
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License Number State | CT
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