Provider Demographics
NPI:1407941594
Name:STOVALL, LESA LANIUS (CPE)
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:LANIUS
Last Name:STOVALL
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4267
Mailing Address - Country:US
Mailing Address - Phone:615-449-4915
Mailing Address - Fax:
Practice Address - Street 1:206B BABB DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2508
Practice Address - Country:US
Practice Address - Phone:615-443-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNELE0000000155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist