Provider Demographics
NPI:1598823304
Name:STONE, LISA K (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:STONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:CHRISTIANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:231-922-9270
Mailing Address - Fax:231-922-9271
Practice Address - Street 1:1221 SOUTH DRIVE
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3255
Practice Address - Country:US
Practice Address - Phone:989-772-6821
Practice Address - Fax:231-922-9271
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1022872 MONITOROtherMCLAREN HEALTH PLAN
MI381908328-373OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI1022873 DRGOtherMCLAREN HEALTH PLAN
MI381908328OtherPRIORITY HEALTH OF MICHIGAN
MI381908328-370OtherCOMMUNITY CHOICE/CARE SOURCE
MI1022871 RUFFINOtherMCLAREN HEALTH PLAN
MI381908328-366OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI381908328-372OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI381908328-368OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI1023384 BRIDGEPORTOtherMCLAREN HEALTH PLAN
MI381908328-369OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI4549956OtherMOLINA HEALTH CARE OF MI
MI1022696 JANES ST.OtherMCLAREN HEALTH PLAN
MI159123OtherGREAT LAKES HEALTH PLAN
MI381908328-367OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI381908328-371OtherCOMMUNITY CHOICE MICHIGAN/CARE SOURCE
MI159123OtherGREAT LAKES HEALTH PLAN
MIQ34896Medicare UPIN
MI0M93030012Medicare PIN