MEDICARE: MRS. SUSAN LYNN STEFANSKI FNP

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	363LP2300X	Primary Care Nurse Practitioner	209015839	IL
2	363L00000X	Nurse Practitioner	291364	AZ
3	363LP2300X	Primary Care Nurse Practitioner	209-015839	IL

General Provider Information

NPI Number	:	1720511645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN LYNN STEFANSKI FNP

Provider Business Mailing Address
First Line	:	PO BOX 18892
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4083
Country	:	US
Telephone Number	:	469-803-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	26900 N LAKE PLEASANT PKWY STE 210
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1558
Country	:	US
Telephone Number	:	623-561-3000
Fax Number	:

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

Provider Enumeration Date	:	04/07/2017
Last Update Date	:	12/11/2025

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