Provider Demographics
NPI:1184725285
Name:BIRDSALL, STEPHANIE JOY (PMHNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOY
Last Name:BIRDSALL
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 JUNE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2621
Mailing Address - Country:US
Mailing Address - Phone:207-490-7000
Mailing Address - Fax:207-490-7002
Practice Address - Street 1:2804 W NORTHERN LIGHTS BLVD STE 280
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3300
Practice Address - Country:US
Practice Address - Phone:907-885-6288
Practice Address - Fax:907-290-8525
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181033363LP0808X
AKNUR U 1335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health