Healthcare Provider Details

I. General information

NPI: 1497818132
Provider Name (Legal Business Name): STEPHENIE RENEE LISTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHENIE RENEE LOFERSKI RN

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 MARTIN LOOP
FORT BENNING GA
31905-5647
US

IV. Provider business mailing address

6900 SCHOMBURG RD APT 609
COLUMBUS GA
31909-1505
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-2802
  • Fax:
Mailing address:
  • Phone: 706-221-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: