Basic Information
| Provider Information | |||||||||
| NPI: | 1770799512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANGE | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | LOU | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4082 GARDNER AVE | ||||||||
| Address2: | |||||||||
| City: | BERKLEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480721435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482768000 | ||||||||
| FaxNumber: | 2482769280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1270 DORIS RD | ||||||||
| Address2: | |||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483262617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2472768000 | ||||||||
| FaxNumber: | 2482769280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 4704166255 | MI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.