Individual
LISA R. STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-6322
(260) 434-6481
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001366A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200387770
—
IN
Enumeration date
06/21/2006
Last updated
12/16/2025
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