MEDICARE: AIMEE M STEFANSKI MS, APRN, BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	E61345	CT
2	363L00000X	Nurse Practitioner	003278	CT

General Provider Information

NPI Number	:	1104804392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE M STEFANSKI MS, APRN, BS

Provider Business Mailing Address
First Line	:	79 WAWECUS ST
Second Line	:	SUITE 106
City	:	NORWICH
State	:	CT
Zip	:	06360-2160
Country	:	US
Telephone Number	:	860-886-2679
Fax Number	:	860-889-2862

Provider Business Practice Location Address
First Line	:	79 WAWECUS ST
Second Line	:	SUITE 106
City	:	NORWICH
State	:	CT
Zip	:	06360-2160
Country	:	US
Telephone Number	:	860-886-2679
Fax Number	:	860-889-2862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	02/07/2014

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