Provider Demographics
NPI:1851652820
Name:STEPHENSON, LISA R (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:R
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 DICKINSON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3387
Mailing Address - Country:US
Mailing Address - Phone:219-926-7755
Mailing Address - Fax:219-929-1885
Practice Address - Street 1:650 DICKINSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304
Practice Address - Country:US
Practice Address - Phone:219-926-7755
Practice Address - Fax:219-929-1885
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160803A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner