Active NPI
Lisa Stadum, NP
- Family Nurse Practitioner
- Prescott, AZ
National Provider Identifier
1063577161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP2577
- Practice address
- 2100 Centerpointe West Dr
Prescott, AZ 86301-8487 - Phone
- (928) 717-0788
- Fax
- (928) 717-0748
- NPI assigned
- Dec 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP2577 | AZ | Primary |
Addresses
Primary practice location
2100 Centerpointe West Dr
Prescott, AZ 86301-8487
Mailing address
2100 Centerpointe West Dr
Prescott, AZ 86301-8487
Phone (928) 717-0788
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313539200000",
"number": "1063577161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 CENTERPOINTE WEST DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863018487",
"telephone_number": "928-717-0788",
"fax_number": "928-717-0748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 CENTERPOINTE WEST DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863018487",
"telephone_number": "928-717-0788",
"fax_number": "928-717-0748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STADUM",
"first_name": "LISA",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-27",
"last_updated": "2011-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AZ",
"license": "AP2577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.