Individual
STEPHANIE FASSU NOULAHEU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1 SHAWS CV, NEW LONDON, CT 06320-4902
(860) 447-8304
Mailing address
575 MAIN ST FL 2, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2845
(860) 347-6971
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
107156
CT
163W00000X
Registered Nurse
774686
CA
363LF0000X
Family Nurse Practitioner
Primary
005102
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
07/17/2012
Last updated
10/22/2012
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