Provider Demographics
NPI:1245055581
Name:LAURENDEAU, STEPHANIE A (PHMHP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:LAURENDEAU
Suffix:
Gender:F
Credentials:PHMHP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03221-0482
Mailing Address - Country:US
Mailing Address - Phone:603-748-6579
Mailing Address - Fax:
Practice Address - Street 1:35 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5413
Practice Address - Country:US
Practice Address - Phone:603-865-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH049031-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty