Individual
MRS. LISA D STULTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1907 W SYCAMORE ST, KOKOMO, IN 46901-5148
(765) 456-5900
Mailing address
10330 N MERIDIAN ST # 300, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71001805A
IN
363LF0000X
Family Nurse Practitioner
Primary
71001805A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000556066
ANTHEM-BCBS
IN
05
—
1033181599
—
MI
05
—
200522480
—
IN
Enumeration date
02/07/2006
Last updated
02/09/2018
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