Provider Demographics
NPI:1033155726
Name:STANLEY, LISA R (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:STANLEY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-434-6322
Practice Address - Fax:260-434-6481
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2025-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71001366A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200387770Medicaid
INP76308Medicare UPIN
IN200387770Medicaid
INP00800420Medicare PIN