Provider Demographics
NPI:1427754464
Name:STALLMAN, LISA (RN-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STALLMAN
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7583 E COUNTY ROAD 2000 N
Mailing Address - Street 2:
Mailing Address - City:FERDINAND
Mailing Address - State:IN
Mailing Address - Zip Code:47532-7517
Mailing Address - Country:US
Mailing Address - Phone:812-309-1986
Mailing Address - Fax:
Practice Address - Street 1:7583 E COUNTY ROAD 2000 N
Practice Address - Street 2:
Practice Address - City:FERDINAND
Practice Address - State:IN
Practice Address - Zip Code:47532-7517
Practice Address - Country:US
Practice Address - Phone:812-309-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28174513A163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control