Provider Demographics
NPI:1528123411
Name:STANKOVICH, LISA STEPHENS (CRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:STEPHENS
Last Name:STANKOVICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 FREDONIA HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:PA
Mailing Address - Zip Code:16124-2323
Mailing Address - Country:US
Mailing Address - Phone:724-475-4778
Mailing Address - Fax:724-981-9444
Practice Address - Street 1:87 STAMBAUGH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-2775
Practice Address - Country:US
Practice Address - Phone:724-981-6250
Practice Address - Fax:724-981-2190
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN269050L163W00000X
PATP001671G363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATP001671GOtherLICENSE
PARN 269050LOtherLICENSE