Provider Demographics
NPI:1144261678
Name:STEPHENS, LISA ANN (APRN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:SZCZEPANIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:227 BROOKMEADE CIR
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-4660
Mailing Address - Country:US
Mailing Address - Phone:802-698-8017
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-4563
Practice Address - Fax:603-650-8699
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0502242305363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008943Medicaid
NH30342121Medicaid
P60561Medicare UPIN
NHNP3807Medicare ID - Type Unspecified