Provider Demographics
NPI:1619254521
Name:STANIGER, NICOLE SUZANNE (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SUZANNE
Last Name:STANIGER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:SUZANNE
Other - Last Name:DEMARTIMPREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:PO BOX 1840
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96137
Mailing Address - Country:US
Mailing Address - Phone:530-520-8682
Mailing Address - Fax:972-278-9065
Practice Address - Street 1:214 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:CA
Practice Address - Zip Code:96137
Practice Address - Country:US
Practice Address - Phone:530-520-8682
Practice Address - Fax:972-278-9065
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99150176B00000X
CA176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife