Basic Information
| Provider Information | |||||||||
| NPI: | 1821274242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCREDIE | ||||||||
| FirstName: | STEFANIE | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 ROCHE BROTHERS WAY | ||||||||
| Address2: | TWO WASHINGTON PLACE, SUITE 130 | ||||||||
| City: | NORTH EASTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023561032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088948730 | ||||||||
| FaxNumber: | 5088948732 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 ROCHE BROTHERS WAY | ||||||||
| Address2: | TWO WASHINGTON PLACE, SUITE 130 | ||||||||
| City: | NORTH EASTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023561032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088948730 | ||||||||
| FaxNumber: | 5088948732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 09/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 235811 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.