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General NPI Number Information
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NPI Number | 1669753349
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Entity Type | Individual
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Provider Name | JAYME MARIE LICHTSTEINER APRN
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Gender | Female
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 411 E CHESTNUT ST # STREET7
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City | LOUISVILLE
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State | KY
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Zip | 40202-1713
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Country | US
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Telephone | 502-588-3400
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Fax | 502-588-3401
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 1116512
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 3006974
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License Number State | KY
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