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NPI Code Detail

MEDICARE: ELLEN STEPHENS

MEDICARE: ELLEN STEPHENS
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerF400821-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598863136
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN STEPHENS
Provider Business Mailing Address
First Line : 304 CLARK ST
Second Line :
City : WAYLAND
State : NY
Zip : 14572-1008
Country : US
Telephone Number : 585-728-2237
Fax Number :
Provider Business Practice Location Address
First Line : 115 LIBERTY ST
Second Line :
City : BATH
State : NY
Zip : 14810-1508
Country : US
Telephone Number : 607-776-6577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 01/20/2010

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Directions to “ ELLEN STEPHENS ” Practice Location

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