Healthcare Provider Details

I. General information

NPI: 1629062138
Provider Name (Legal Business Name): CAROLE JOANN STANGER MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLE JOANN HURTT MSN

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 2ND AVE S
MINNEAPOLIS MN
55402-3318
US

IV. Provider business mailing address

304 4TH ST SE
HILLSBORO ND
58045-4908
US

V. Phone/Fax

Practice location:
  • Phone: 612-659-7101
  • Fax:
Mailing address:
  • Phone: 701-636-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1339738
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: