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NPI Code Detail

MEDICARE: STEPHANIE LAURAINE HANENBERG NP

MEDICARE: STEPHANIE LAURAINE HANENBERG NP
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
1363LF0000XFamily Nurse Practitioner102754CO

General Provider Information

NPI Number : 1215123344
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE LAURAINE HANENBERG NP
Provider Business Mailing Address
First Line : 1420 AUSTIN BLUFFS PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3733
Country : US
Telephone Number : 719-262-4444
Fax Number : 719-262-4446
Provider Business Practice Location Address
First Line : 1420 AUSTIN BLUFFS PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3733
Country : US
Telephone Number : 719-262-4444
Fax Number : 719-262-4446
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2007
Last Update Date : 09/21/2007

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