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General NPI Number Information
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NPI Number | 1083992556
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Entity Type | Individual
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Provider Name | MARK LANE STEPHENS FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 920 OLIVER RD
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City | MONROE
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State | LA
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Zip | 71201-5702
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Country | US
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Telephone | 318-807-4713
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Fax | 318-807-1833
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Provider Business Mailing Address
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Address Line | 130 DESIARD ST SUITE 355
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City | MONROE
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State | LA
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Zip | 71201-7319
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Country | US
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Telephone | 318-807-7875
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Fax | 318-812-6603
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN089763-AP06597
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License Number State | LA
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