Individual
MARK LANE STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
920 OLIVER RD, MONROE, LA 71201-5702
(318) 807-4713
(318) 807-1833
Mailing address
130 DESIARD ST, SUITE 355, MONROE, LA 71201-7319
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN089763-AP06597
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2174711
—
LA
Enumeration date
08/01/2011
Last updated
06/13/2019
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