Provider Demographics
NPI:1154388072
Name:STEPHENS, LONE BIRGIT (PA-C)
Entity type:Individual
Prefix:
First Name:LONE
Middle Name:BIRGIT
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1625
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-1625
Mailing Address - Country:US
Mailing Address - Phone:928-645-9675
Mailing Address - Fax:928-645-2626
Practice Address - Street 1:I-15 EXIT 9 AT THE FIRESTATION
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:AZ
Practice Address - Zip Code:86432-0490
Practice Address - Country:US
Practice Address - Phone:928-347-5971
Practice Address - Fax:928-347-5793
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV657363LC0200X
AZ3424363AM0700X
UT104953-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ096750Medicaid
AZ096750Medicaid
AZ109903, 109904Medicare ID - Type UnspecifiedMEDICARE