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NPI Code Detail

MEDICARE: STEPHANIE T LENNON APRN

MEDICARE: STEPHANIE T LENNON APRN
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
1363LF0000XFamily Nurse Practitioner003468CT
2363LP2300XPrimary Care Nurse Practitioner003468CT

General Provider Information

NPI Number : 1487713947
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE T LENNON APRN
Provider Business Mailing Address
First Line : 126 ALPINE DR
Second Line :
City : SANDY HOOK
State : CT
Zip : 06482-1254
Country : US
Telephone Number : 860-933-6784
Fax Number :
Provider Business Practice Location Address
First Line : 2620 KESSLER BOULEVARD EAST DR STE 110
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-2889
Country : US
Telephone Number : --
Fax Number : 203-720-6996
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 05/16/2023

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