Provider Demographics
NPI:1487713947
Name:LENNON, STEPHANIE T (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:LENNON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1254
Mailing Address - Country:US
Mailing Address - Phone:860-933-6784
Mailing Address - Fax:
Practice Address - Street 1:2620 KESSLER BOULEVARD EAST DR STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2889
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:203-720-6996
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003468363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily