Healthcare Provider Details

I. General information

NPI: 1013188135
Provider Name (Legal Business Name): MARY R STANGE RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE., ML 4009
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE., ML 5021
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7480
  • Fax: 513-636-7360
Mailing address:
  • Phone: 513-636-0356
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SR0400X
TaxonomyRehabilitation Clinical Nurse Specialist
License NumberCOA.05711-NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: