Provider Demographics
NPI:1427226828
Name:DEGURSKI, STEPHEN C (LIC AC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:DEGURSKI
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3160
Mailing Address - Country:US
Mailing Address - Phone:413-586-8910
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3160
Practice Address - Country:US
Practice Address - Phone:413-586-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363171100000X
MA268661363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No171100000XOther Service ProvidersAcupuncturist