Provider Demographics
NPI:1538117312
Name:SPANGLER, STEPHANIE BARTLETT (PA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BARTLETT
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 GRAMMONT ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7457
Mailing Address - Country:US
Mailing Address - Phone:318-323-6603
Mailing Address - Fax:318-387-3601
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-323-6603
Practice Address - Fax:318-387-3601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363A00000X363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1769886Medicaid
LA5C349P646Medicare ID - Type Unspecified
LAQ38224Medicare UPIN