Provider Demographics
NPI:1487454849
Name:ACKERMAN, STEPHANIE GRACE (PMHNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GRACE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1653
Mailing Address - Country:US
Mailing Address - Phone:484-633-2642
Mailing Address - Fax:
Practice Address - Street 1:887 MARKET ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1653
Practice Address - Country:US
Practice Address - Phone:484-633-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032058363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health