Provider Demographics
NPI:1447303961
Name:CHIN, STEPHANIE ELENA (FNP-BC, APRN-CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELENA
Last Name:CHIN
Suffix:
Gender:F
Credentials:FNP-BC, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PUNKIN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-3425
Mailing Address - Country:US
Mailing Address - Phone:207-595-8756
Mailing Address - Fax:
Practice Address - Street 1:LIBERTY BAY RECOVERY CENTER
Practice Address - Street 2:343 FOREST AVENUE
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-772-9800
Practice Address - Fax:207-536-1511
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily