Healthcare Provider Details

I. General information

NPI: 1558357749
Provider Name (Legal Business Name): LYN MARIE STEVENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N NAPPANEE ST
ELKHART IN
46514-1957
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-206-0305
  • Fax: 574-206-0310
Mailing address:
  • Phone: 574-647-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71001040A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: