Provider Demographics
NPI:1053819292
Name:STEPHANIE SLOAN
Entity Type:Organization
Organization Name:STEPHANIE SLOAN
Other - Org Name:STEPHANIE SLOAN APRN LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:267-664-8281
Mailing Address - Street 1:12 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:QUAKER HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06375-1117
Mailing Address - Country:US
Mailing Address - Phone:267-664-8281
Mailing Address - Fax:
Practice Address - Street 1:627 NORWICK NEW LONDON TURNPIKE
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2122
Practice Address - Country:US
Practice Address - Phone:267-664-8281
Practice Address - Fax:207-637-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005618163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0138107OtherANCC CERTIFICATE