Healthcare Provider Details

I. General information

NPI: 1609620830
Provider Name (Legal Business Name): ISABEL MARIE BANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S RANGE AVE
COLBY KS
67701-2958
US

IV. Provider business mailing address

835 LANE DR
COLBY KS
67701-2730
US

V. Phone/Fax

Practice location:
  • Phone: 785-460-4596
  • Fax:
Mailing address:
  • Phone: 785-269-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159147
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: