Provider Demographics
NPI:1629062138
Name:STANGER, CAROLE JOANN (MSN)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:JOANN
Last Name:STANGER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:JOANN
Other - Last Name:HURTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:304 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-4908
Mailing Address - Country:US
Mailing Address - Phone:701-636-4751
Mailing Address - Fax:
Practice Address - Street 1:920 2ND AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-3318
Practice Address - Country:US
Practice Address - Phone:612-659-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1339738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1629062138Medicare PIN
MN500002897Medicare UPIN
Q34891Medicare UPIN