Provider Demographics
NPI:1811506397
Name:ATHANASOPOULOS, STELLA (MSN, RN, CNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:ATHANASOPOULOS
Suffix:
Gender:F
Credentials:MSN, RN, CNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BOWLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1802
Mailing Address - Country:US
Mailing Address - Phone:978-335-1058
Mailing Address - Fax:
Practice Address - Street 1:632 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3293
Practice Address - Country:US
Practice Address - Phone:617-825-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2334929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily