Provider Demographics
NPI:1215367206
Name:CHANGEAU, STEPHANIE (MSN,FNP BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CHANGEAU
Suffix:
Gender:F
Credentials:MSN,FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1817
Mailing Address - Country:US
Mailing Address - Phone:508-533-6771
Mailing Address - Fax:508-533-9475
Practice Address - Street 1:67 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1817
Practice Address - Country:US
Practice Address - Phone:508-533-6771
Practice Address - Fax:508-533-9475
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2261511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily