Healthcare Provider Details

I. General information

NPI: 1356330435
Provider Name (Legal Business Name): STEPHANIE BRYANT-LIPP NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 N EAST ST
INDIANAPOLIS IN
46202-3425
US

IV. Provider business mailing address

5150 SHELBYVILLE RD
INDIANAPOLIS IN
46237-2601
US

V. Phone/Fax

Practice location:
  • Phone: 317-429-0120
  • Fax:
Mailing address:
  • Phone: 317-782-1577
  • Fax: 317-780-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number710201147A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: