1518006287 NPI number — MS. ANGELA SUE STUKENBERG M.A.

Table of content: MS. ANGELA SUE STUKENBERG M.A. (NPI 1518006287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518006287 NPI number — MS. ANGELA SUE STUKENBERG M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUKENBERG
Provider First Name:
ANGELA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
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:
1518006287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 S 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTAGE GROVE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97424-2775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-687-6983
Provider Business Mailing Address Fax Number:
541-687-2063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1255 PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-3570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-687-6983
Provider Business Practice Location Address Fax Number:
541-687-2063
Provider Enumeration Date:
02/06/2007

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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