| NPI | 1700070612 |
|---|---|
| Former Name | LISA RAE STEPHENS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 123240030 3189) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 3189) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2023-01-23 |