Provider Demographics
NPI:1720365315
Name:STENGEL, JAN MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:MICHELLE
Last Name:STENGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11602 W 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4313
Mailing Address - Country:US
Mailing Address - Phone:303-421-5237
Mailing Address - Fax:303-421-0518
Practice Address - Street 1:11602 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4313
Practice Address - Country:US
Practice Address - Phone:303-421-5237
Practice Address - Fax:303-421-0518
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14812OtherLICENSE NUMBER