Healthcare Provider Details

I. General information

NPI: 1083144539
Provider Name (Legal Business Name): ALISHA STINEMETZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W NOBLE ST
LYONS KS
67554-3026
US

IV. Provider business mailing address

1221 W NOBLE ST
LYONS KS
67554-3026
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-5124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77698-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: