Provider Demographics
NPI:1396938189
Name:MUNCHOFF, STEPHANIE (RN, RD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:MUNCHOFF
Suffix:
Gender:F
Credentials:RN, RD
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 1453
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-1453
Mailing Address - Country:US
Mailing Address - Phone:970-513-1900
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-2280
Practice Address - Country:US
Practice Address - Phone:970-668-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172146163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32530838Medicaid