Provider Demographics
NPI:1437593761
Name:HOROHO, STEFANIE VERONICA (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:VERONICA
Last Name:HOROHO
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:VERONICA
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CPNP
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-0610
Mailing Address - Fax:617-734-1034
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-0610
Practice Address - Fax:617-734-1034
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN281364363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110123790AMedicaid