Provider Demographics
NPI:1932125754
Name:STANGE, EMILY SUSAN (CNM, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:SUSAN
Last Name:STANGE
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:VT
Mailing Address - Zip Code:05088-0721
Mailing Address - Country:US
Mailing Address - Phone:802-295-5221
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH052190-23-04363LW0102X
NH052190-23-01367A00000X
VT101-0028642367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342923Medicaid
VT1010441Medicaid
VT1010441Medicaid
NH30342923Medicaid