Healthcare Provider Details

I. General information

NPI: 1265774269
Provider Name (Legal Business Name): LISA ANN STIER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 BOURN ST
LEWISTON MI
49756-8134
US

IV. Provider business mailing address

1996 WALDEN DR MHC OMH WALK-IN CLINIC
GAYLORD MI
49735-8241
US

V. Phone/Fax

Practice location:
  • Phone: 989-786-4877
  • Fax: 989-786-2187
Mailing address:
  • Phone: 989-731-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704175992
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: