Provider Demographics
NPI:1952776213
Name:NUNES, STEPHANIE MAIRE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MAIRE
Last Name:NUNES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1932
Mailing Address - Country:US
Mailing Address - Phone:774-501-8117
Mailing Address - Fax:
Practice Address - Street 1:385 BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3059
Practice Address - Country:US
Practice Address - Phone:781-485-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2292716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily