Individual
PAUL CHRISTIAN STIVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 502-4000
Mailing address
710 VETERANS MEMORIAL PKWY W APT 13, LAFAYETTE, IN 47909-6960
(765) 412-7371
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004156A
IN
Other
Enumeration date
08/16/2023
Last updated
10/26/2023
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