Healthcare Provider Details

I. General information

NPI: 1851652820
Provider Name (Legal Business Name): LISA R STEPHENSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA R LEE

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 DICKINSON RD
CHESTERTON IN
46304
US

IV. Provider business mailing address

650 DICKINSON RD
CHESTERTON IN
46304-3387
US

V. Phone/Fax

Practice location:
  • Phone: 219-926-7755
  • Fax: 219-929-1885
Mailing address:
  • Phone: 219-926-7755
  • Fax: 219-929-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28160803A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: