MEDICARE: MARY R STANGE RN, CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SR0400X	Rehabilitation Clinical Nurse Specialist	COA.05711-NS	OH

General Provider Information

NPI Number	:	1013188135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY R STANGE RN, CNS

Provider Business Mailing Address
First Line	:	3333 BURNET AVE., ML 5021
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3039
Country	:	US
Telephone Number	:	513-636-0356
Fax Number	:	513-636-2511

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE., ML 4009
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3039
Country	:	US
Telephone Number	:	513-636-7480
Fax Number	:	513-636-7360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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