Provider Demographics
NPI:1245221811
Name:MACUMBER, STELLA LEIGH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:LEIGH
Last Name:MACUMBER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 E ARAPAHOE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3703
Mailing Address - Country:US
Mailing Address - Phone:303-835-9915
Mailing Address - Fax:303-320-5399
Practice Address - Street 1:9620 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80112-3703
Practice Address - Country:US
Practice Address - Phone:303-835-9915
Practice Address - Fax:303-320-5399
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P52199Medicare UPIN