Provider Demographics
NPI:1831522580
Name:STAHL, JENNIFER (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 HAMPSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5221
Mailing Address - Country:US
Mailing Address - Phone:970-433-7154
Mailing Address - Fax:
Practice Address - Street 1:2444 HAMPSTEAD DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5221
Practice Address - Country:US
Practice Address - Phone:970-433-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1622081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse