MEDICARE: ALICE RENEE STAHL R.N.

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	163W00000X	Registered Nurse	49586	CO

General Provider Information

NPI Number	:	1962667626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE RENEE STAHL R.N.

Provider Business Mailing Address
First Line	:	3090 ABERDEEN LN
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-6263
Country	:	US
Telephone Number	:	970-523-1387
Fax Number	:	970-523-1387

Provider Business Practice Location Address
First Line	:	510 29.5 RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5383
Country	:	US
Telephone Number	:	970-254-4103
Fax Number	:	970-254-4118

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

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	07/22/2008

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