Provider Demographics
NPI:1104804392
Name:STEFANSKI, AIMEE M (MS, APRN, BS)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:M
Last Name:STEFANSKI
Suffix:
Gender:F
Credentials:MS, APRN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WAWECUS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2160
Mailing Address - Country:US
Mailing Address - Phone:860-886-2679
Mailing Address - Fax:860-889-2862
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-886-2679
Practice Address - Fax:860-889-2862
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE61345363LA2200X
CT003278363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q49686Medicare UPIN
CT500001517Medicare ID - Type Unspecified