Provider Demographics
NPI:1770544975
Name:MACCONNELL, STEPHANIE JANE (NP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JANE
Last Name:MACCONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822-1102
Mailing Address - Country:US
Mailing Address - Phone:518-654-6420
Mailing Address - Fax:
Practice Address - Street 1:950 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3667
Practice Address - Country:US
Practice Address - Phone:518-373-1165
Practice Address - Fax:518-348-1849
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420497363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health