Provider Demographics
NPI:1740615855
Name:STENGER, ELIZABETH AMANDA (MT, (ASCP)CM)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:AMANDA
Last Name:STENGER
Suffix:
Gender:F
Credentials:MT, (ASCP)CM
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:AMANDA
Other - Last Name:GURROLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT, (ASCP)CM
Mailing Address - Street 1:10444 CALLE AVILA NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1804
Mailing Address - Country:US
Mailing Address - Phone:505-610-0490
Mailing Address - Fax:
Practice Address - Street 1:10444 CALLE AVILA NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1804
Practice Address - Country:US
Practice Address - Phone:505-610-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM04136035291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO576217764OtherVETERANS ADMINSTRATION