Provider Demographics
NPI:1265516702
Name:STANGE, JACQUELYN C (NP-C)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:C
Last Name:STANGE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:C
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3800 S NATIONAL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5209
Mailing Address - Country:US
Mailing Address - Phone:417-269-5506
Mailing Address - Fax:417-269-2099
Practice Address - Street 1:3800 S NATIONAL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5209
Practice Address - Country:US
Practice Address - Phone:417-269-5506
Practice Address - Fax:417-269-2099
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily