Provider Demographics
NPI:1104488410
Name:WARREN, STEFANIE LYNN (FNP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LYNN
Last Name:WARREN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 TEAR CAP RD
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:ME
Mailing Address - Zip Code:04041-3126
Mailing Address - Country:US
Mailing Address - Phone:407-668-3954
Mailing Address - Fax:
Practice Address - Street 1:400 ENTERPRISE DR STE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7663
Practice Address - Country:US
Practice Address - Phone:207-289-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily