Individual
LISA M REPKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1606 N 7TH ST., TERRE HAUTE, IN 47804-2706
(217) 443-5000
Mailing address
250 N SHADELAND AVE, SUITE 130- PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(866) 916-5259
(231) 922-4030
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-002189
IL
363A00000X
Physician Assistant
Primary
10001476A
IN
363A00000X
Physician Assistant
5601003446
MI
Other
Enumeration date
07/17/2006
Last updated
02/28/2017
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