=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457470734
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSSA IRENE STINGLRY B.A AND M.A. C.C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 07/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8912 VOLUNTEER LN
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95826-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-417-8689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9237 GREENBACK LN APT 56
-----------------------------------------------------
City | ORANGEVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95662-4850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-616-3545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------