Provider Demographics
NPI:1639159783
Name:STEFANOWICZ, LESLIE ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANNE
Last Name:STEFANOWICZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:35 PEARL ST
Mailing Address - Street 2:STE 300
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2866
Mailing Address - Country:US
Mailing Address - Phone:508-638-4506
Mailing Address - Fax:508-580-4664
Practice Address - Street 1:35 PEARL ST
Practice Address - Street 2:STE 300
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2866
Practice Address - Country:US
Practice Address - Phone:508-584-6300
Practice Address - Fax:508-580-4664
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233927363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0383350Medicaid
MA0383350Medicaid
MANP329401Medicare PIN