Provider Demographics
NPI:1871251702
Name:OLIVARES, STEPHANIE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:FULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 LIME KILN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVERHILL
Mailing Address - State:NH
Mailing Address - Zip Code:03774-5721
Mailing Address - Country:US
Mailing Address - Phone:603-372-7321
Mailing Address - Fax:
Practice Address - Street 1:25 MOUNT EUSTIS RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3712
Practice Address - Country:US
Practice Address - Phone:603-444-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH079750-23363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care