1265403901 NPI number — MRS. LUCINDA DIANE STEGMAN FNP-ACNP

Table of content: MRS. LUCINDA DIANE STEGMAN FNP-ACNP (NPI 1265403901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265403901 NPI number — MRS. LUCINDA DIANE STEGMAN FNP-ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEGMAN
Provider First Name:
LUCINDA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265403901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 E ROUTT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81004-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-563-8711
Provider Business Mailing Address Fax Number:
719-543-5340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 COLORADO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81004-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-543-8711
Provider Business Practice Location Address Fax Number:
719-543-5340
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  118291 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: R58496 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 4811 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 94807353 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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