Healthcare Provider Details

I. General information

NPI: 1811169972
Provider Name (Legal Business Name): STACEY MARIE PARKER-BRUEGGEMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BOB PETERS GRV STE 202
COLORADO SPRINGS CO
80909-4533
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6568
  • Fax: 719-365-6317
Mailing address:
  • Phone: 970-624-2417
  • Fax: 970-490-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD42742
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberDR.0065986
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2011011830
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: