MEDICARE: VICTORIA STANGER PA-C

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	207Q00000X	Family Medicine Physician	176411-1206	UT

General Provider Information

NPI Number	:	1821165424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA STANGER PA-C

Provider Business Mailing Address
First Line	:	1291 N 1500 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-1644
Country	:	US
Telephone Number	:	801-531-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1291 N 1500 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-1644
Country	:	US
Telephone Number	:	801-531-7217
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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Directions to “ VICTORIA STANGER PA-C” Practice Location

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