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General NPI Number Information
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NPI Number | 1497930176
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Entity Type | Individual
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Provider Name | LISA MARIE STOLARCZYK M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 8208 LOUISIANA BLVD NE STE C
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1759
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Country | US
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Telephone | 505-858-1222
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Fax | 505-858-1224
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Provider Business Mailing Address
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Address Line | 2510 W DUNLAP AVE STE 290
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City | PHOENIX
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State | AZ
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Zip | 85021-2759
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Country | US
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Telephone | 602-789-0344
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Fax | 602-870-7566
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2010-0743
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61511712
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License Number State | WA
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