MRS. LISA D RADERSTORF (NPI# 1245421031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245421031 |
| Entity Type | Individual |
| Full Name | MRS. LISA D RADERSTORF |
| Other Name | LISA DAWN NOLLENBERGER |
| Credential | PA-C |
| Practice Address |
5838 W Brick Rd Suite 106 South Bend IN 46628-8423 |
| Mailing Address |
Po Box 1239 Troy MI 48099-1239 |
| Practice Telephone | 5742471911 |
| Practice Fax Number | 5742471912 |
| Mailing Telephone | 2488246600 |
| Mailing Fax Number | 2483241477 |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2011-12-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10000915A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM BLUE CROSS | 000000527324 | 01 |
| Street Address |
5838 W BRICK RD SUITE 106 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46628-8423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780012682 | Vpa PC | Radiology | 5838 W Brick Rd, South Bend, IN 46628-8423 | 2013-10-31 |
| 1134563166 | Jamie Hugh Stone | Internal Medicine | 5838 W Brick Rd, Ste 106, South Bend, IN 46628-8423 | 2013-04-21 |
| 1790098879 | Life In Balance, LLC | Physical Therapist | 5838 W Brick Rd, Suite 104-b, South Bend, IN 46628-8423 | 2010-07-19 |
| 1366768160 | Vpa PC | Internal Medicine | 5838 W Brick Rd, #106, South Bend, IN 46628-8420 | 2010-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700419249 | Mahogany Maternity | Doula | 22500 Lincoln Way West, South Bend, IN 46628 | 2020-02-12 |
| 1093126120 | Julie Collier | Pharmacist | 3600 Northportage Road, South Bend, IN 46628 | 2014-05-12 |
| 1588075717 | J Curylo | Pharmacist | 3600 N Portage Rd, South Bend, IN 46628 | 2014-05-09 |
| 1609287986 | Thomas Daniels | Pharmacist | 3600 North Portage Rd., South Bend, IN 46628 | 2014-05-08 |
| 1639467277 | United Seating and Mobility LLC | Durable Medical Equipment & Medical Supplies | 3371 Cleveland Rd Ste 310, South Bend, IN 46628 | 2011-07-18 |
| 1497891014 | Danielle Colleen Luten | Homemaker | 1830 N Brookfield, South Bend, IN 46628 | 2007-01-30 |
| 1700885498 | Stephen D Kennedy | Family Medicine | 5838 W Brick Rd Ste 106, South Bend, IN 46628 | 2005-07-15 |
| 1205440666 | Kristin Lynette Stringer | Registered Nurse | 53174 Flowing Stream Ct, South Bend, IN 46628 | 2020-09-03 |
| 1033489844 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 3600 Portage Rd, South Bend, IN 46628 | 2012-01-10 |
| 1467687277 | Leah Diane Craft | Family Medicine | 2235 Cleveland Rd, South Bend, IN 46628 | 2009-05-22 |
| Find all providers in zip 46628 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316167307 | Dwaine Siade | Physician Assistant | 611 Lincoln Way East Suite 1, South Bend, IN 46601 | 2007-05-01 |
| 1699764308 | Gary L. Armock | Physician Assistant | 53880 Carmichael Dr, South Bend, IN 46635-1567 | 2005-10-14 |
| 1568454940 | Sheri A Wilson | Physician Assistant | 1245 E Ireland Rd, South Bend, IN 46614-3448 | 2005-08-22 |
| 1740803238 | Taylor Reinhardt | Physician Assistant | 615 N Michigan St, South Bend, IN 46601-1033 | 2020-05-19 |
| 1073155420 | Priya Kaur | Physician Assistant | 1245 E Ireland Rd, South Bend, IN 46614-3448 | 2019-10-16 |
| 1730720301 | Mackenzie S Warrick | Physician Assistant | 53880 Carmichael Dr, South Bend, IN 46635-1567 | 2019-10-03 |
| 1649736604 | Meghan M. Hart | Physician Assistant | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2019-02-14 |
| 1477021038 | Ashlee Dennise Swafford | Physician Assistant | 615 N Michigan St, South Bend, IN 46601-1033 | 2018-11-12 |
| 1801300330 | Alejandro Mikelonis | Physician Assistant | 610 N Michigan St Ste 306, South Bend, IN 46601-1079 | 2017-11-20 |
| 1295256808 | Elizabeth D. Progar | Physician Assistant | 610 N Michigan St Ste 306, South Bend, IN 46601-1079 | 2017-07-05 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46628 |
Please comment or provide details below to improve the information on MRS. LISA D RADERSTORF.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.