Individual
LISA STADUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2100 CENTERPOINTE WEST DR, PRESCOTT, AZ 86301-8487
(928) 717-0788
(928) 717-0748
Mailing address
2100 CENTERPOINTE WEST DR, PRESCOTT, AZ 86301-8487
(928) 717-0788
(928) 717-0748
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP2577
AZ
Other
Enumeration date
12/27/2006
Last updated
08/17/2011
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