Provider Demographics
NPI:1619527686
Name:LOTHAMER, STEPHANIE (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LOTHAMER
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 W HOOSIER ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-1019
Mailing Address - Country:US
Mailing Address - Phone:260-216-5690
Mailing Address - Fax:260-200-5472
Practice Address - Street 1:524 W HOOSIER ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1019
Practice Address - Country:US
Practice Address - Phone:260-216-5690
Practice Address - Fax:260-200-5472
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000332A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife