Provider Demographics
NPI:1417957762
Name:BARBEAU, STEPHANIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:BARBEAU
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 1:242 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1248
Mailing Address - Country:US
Mailing Address - Phone:978-922-3209
Mailing Address - Fax:
Practice Address - Street 1:1 HUTCHINSON DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3748
Practice Address - Country:US
Practice Address - Phone:978-739-6950
Practice Address - Fax:978-777-9274
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9784403Medicaid
MA9784403Medicaid
MANP4056Medicare ID - Type Unspecified