Provider Demographics
NPI:1467785865
Name:STANGONI, MARTHA (RN, MSN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:STANGONI
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:MARTIE
Other - Middle Name:
Other - Last Name:STANGONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN
Mailing Address - Street 1:6 GARDEN CTR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1730
Mailing Address - Country:US
Mailing Address - Phone:720-887-2247
Mailing Address - Fax:720-887-2229
Practice Address - Street 1:6 GARDEN CTR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1730
Practice Address - Country:US
Practice Address - Phone:720-887-2247
Practice Address - Fax:720-887-2229
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO186573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse