MEDICARE: LISA STEVENS CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	0024166990	VA
2	367A00000X	Advanced Practice Midwife	164	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN3911	OTHER	VA	RAILROAD MEDICARE PTAN
5	C02245	OTHER	VA	MEDICARE PTAN
6	018694O45	OTHER	VA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	210104	OTHER	VA	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	10012208M	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1215965074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA STEVENS CNM

Provider Business Mailing Address
First Line	:	10 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1808
Country	:	US
Telephone Number	:	919-212-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1808
Country	:	US
Telephone Number	:	919-212-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	12/08/2022

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Directions to “ LISA STEVENS CNM” Practice Location

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