Healthcare Provider Details

I. General information

NPI: 1528123411
Provider Name (Legal Business Name): LISA STEPHENS STANKOVICH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 STAMBAUGH AVE SUITE 1
SHARON PA
16146-2775
US

IV. Provider business mailing address

163 FREDONIA HADLEY RD
FREDONIA PA
16124-2323
US

V. Phone/Fax

Practice location:
  • Phone: 724-981-6250
  • Fax: 724-981-2190
Mailing address:
  • Phone: 724-475-4778
  • Fax: 724-981-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN269050L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP001671G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: