Provider Demographics
NPI:1972581189
Name:STETSON, ANNE ELIZABETH (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ANNE
Middle Name:ELIZABETH
Last Name:STETSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ANNE
Other - Middle Name:ELIZABETH
Other - Last Name:BORAWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:441 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9756
Mailing Address - Country:US
Mailing Address - Phone:413-584-4808
Mailing Address - Fax:413-584-4808
Practice Address - Street 1:441 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9756
Practice Address - Country:US
Practice Address - Phone:413-584-4808
Practice Address - Fax:413-584-4808
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1783Medicare ID - Type Unspecified
P66245Medicare UPIN