MEDICARE: STEPHANIE BRYANT-LIPP NPC

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	363L00000X	Nurse Practitioner	710201147A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356330435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BRYANT-LIPP NPC

Provider Business Mailing Address
First Line	:	5150 SHELBYVILLE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-2601
Country	:	US
Telephone Number	:	317-782-1577
Fax Number	:	317-780-5539

Provider Business Practice Location Address
First Line	:	907 N EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3425
Country	:	US
Telephone Number	:	317-429-0120
Fax Number	:

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	08/01/2024

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