Provider Demographics
NPI:1407108293
Name:BELANGER, STEPHANIE C (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:BELANGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FARM GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1981
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:
Practice Address - Street 1:3 FARM GLEN BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1981
Practice Address - Country:US
Practice Address - Phone:860-284-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005756363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics