Healthcare Provider Details

I. General information

NPI: 1144261678
Provider Name (Legal Business Name): LISA ANN STEPHENS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANN SZCZEPANIAK ARNP

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

227 BROOKMEADE CIR
WHITE RIVER JUNCTION VT
05001-4660
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-4563
  • Fax: 603-650-8699
Mailing address:
  • Phone: 802-698-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0502242305
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: