MEDICARE: STEPHANIE CONNORS NP-C

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	363L00000X	Nurse Practitioner	RN2281788	MA
2	363LC1500X	Community Health Nurse Practitioner	RN2281788	MA
3	363LP2300X	Primary Care Nurse Practitioner	RN2281788	MA

General Provider Information

NPI Number	:	1982011003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CONNORS NP-C

Provider Business Mailing Address
First Line	:	162 CHANDLER ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2924
Country	:	US
Telephone Number	:	508-860-1048
Fax Number	:	508-421-4393

Provider Business Practice Location Address
First Line	:	162 CHANDLER ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2924
Country	:	US
Telephone Number	:	508-860-1048
Fax Number	:	508-421-4393

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

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2014

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