Provider Demographics
NPI:1194796300
Name:STEPHENS, LISA DAHLQUIST (FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DAHLQUIST
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:GERDA
Other - Last Name:DAHLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1 BOONE RD
Mailing Address - Street 2:FAMILY MEDICINE CLINIC NAVAL HOSPITAL
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312
Mailing Address - Country:US
Mailing Address - Phone:360-475-4379
Mailing Address - Fax:360-475-4633
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:FAMILY MEDICINE CLINIC NAVAL HOSPITAL
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:360-475-4379
Practice Address - Fax:360-475-4633
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily