Provider Demographics
NPI:1205860566
Name:STANGEL, JULIANNE MARIE (RN,NP)
Entity Type:Individual
Prefix:MS
First Name:JULIANNE
Middle Name:MARIE
Last Name:STANGEL
Suffix:
Gender:F
Credentials:RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 VISTA HILL CT SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8705
Mailing Address - Country:US
Mailing Address - Phone:505-565-0630
Mailing Address - Fax:
Practice Address - Street 1:1375 VISTA HILL CT SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8705
Practice Address - Country:US
Practice Address - Phone:505-565-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR56770363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXANPO11181Medicaid
TX82N247Medicare ID - Type Unspecified
TXANPO11181Medicaid