Provider Demographics
NPI:1073665832
Name:WILLIAMS, STEPHANIE BRUNS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BRUNS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:BRUNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6055
Mailing Address - Country:US
Mailing Address - Phone:207-636-7428
Mailing Address - Fax:
Practice Address - Street 1:25 JUNE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2621
Practice Address - Country:US
Practice Address - Phone:207-490-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS29199Medicare UPIN