Provider Demographics
NPI:1851114631
Name:STIPPLER, LUCAS (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:
Last Name:STIPPLER
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 S GRACE ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4049
Mailing Address - Country:US
Mailing Address - Phone:812-483-6316
Mailing Address - Fax:
Practice Address - Street 1:711 SAINT MARYS DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0508
Practice Address - Country:US
Practice Address - Phone:812-485-5858
Practice Address - Fax:812-485-5815
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016232A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily