Provider Demographics
NPI:1932857117
Name:SOUSA, STEPHANIE BALZANO (MSN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BALZANO
Last Name:SOUSA
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 WINDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-1135
Mailing Address - Country:US
Mailing Address - Phone:401-301-0207
Mailing Address - Fax:
Practice Address - Street 1:171 WINDWARD WAY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-1135
Practice Address - Country:US
Practice Address - Phone:401-301-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPENDING363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health