Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 25329 | CO |
NPI | 1114077625 |
---|---|
Provider Name | Mary M Stengel |
First Address | Durango, CO 81302-8901 |
Second Address | Durango, CO 81301-7488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01253293 | (05) | CO |
D24613 | (02) | CO |
E6819 | (05) | NM |