Provider Demographics
NPI:1467215707
Name:LUMSDEN, STEPHANIE CAROLYN (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CAROLYN
Last Name:LUMSDEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 SCARLET SAGE CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-2413
Mailing Address - Country:US
Mailing Address - Phone:786-459-7131
Mailing Address - Fax:
Practice Address - Street 1:1034 SCARLET SAGE CIR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-2413
Practice Address - Country:US
Practice Address - Phone:786-459-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN261272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty