Provider Demographics
NPI:1174179501
Name:BELCHER, STEFANIE
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:BELCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NEW WAY LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2358
Mailing Address - Country:US
Mailing Address - Phone:978-290-7954
Mailing Address - Fax:
Practice Address - Street 1:1 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2292
Practice Address - Country:US
Practice Address - Phone:978-281-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2297183363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner