Provider Demographics
NPI:1073511523
Name:STEPHAN, LORENE L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LORENE
Middle Name:L
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:LORENE
Other - Middle Name:L
Other - Last Name:NOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 N MISSOURI
Mailing Address - Street 2:
Mailing Address - City:MARCELINE
Mailing Address - State:MO
Mailing Address - Zip Code:64658
Mailing Address - Country:US
Mailing Address - Phone:660-376-2038
Mailing Address - Fax:660-376-3011
Practice Address - Street 1:1600 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:MARCELINE
Practice Address - State:MO
Practice Address - Zip Code:64658-1012
Practice Address - Country:US
Practice Address - Phone:660-376-2038
Practice Address - Fax:660-376-3011
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44805363LF0000X
MO146404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100358770FMedicaid
KS161414Medicare ID - Type Unspecified
KSS74373Medicare UPIN