Provider Demographics
NPI:1336408798
Name:STANGELAND, ROBERTA MARLENE (RN)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:MARLENE
Last Name:STANGELAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 1/2 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164
Mailing Address - Country:US
Mailing Address - Phone:507-215-1197
Mailing Address - Fax:
Practice Address - Street 1:609 1/2 2ND ST SW
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164
Practice Address - Country:US
Practice Address - Phone:507-215-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 170312-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse