Provider Demographics
NPI:1649761180
Name:SALMONSON, STACEY ELAINE (PMHNP, RXN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ELAINE
Last Name:SALMONSON
Suffix:
Gender:F
Credentials:PMHNP, RXN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:WG703
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1619
Practice Address - Country:US
Practice Address - Phone:413-794-5555
Practice Address - Fax:413-794-9803
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2342234363LP0808X
COAPN.0994059-NP363LP0808X
TNAPN0000023926363LP0808X
COC-APN.0001086-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health