| Doctor Name: | MARY ANN STANGER |
| NPI Number: | 1447527536 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N. D |
| License Number: | 003818076 |
| Business Practice Address: | 3728 N 3700 E Kimberly, ID - 833415087 |
| Business Phone Number: | 2084204460 |
| Business Fax Number: | 2084239007 |
| Mailing Address: | 3728 N 3700 E, KIMBERLY |
| State: | ID |
| Postal Code: | 833415087 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/17/2011 |
| NPI Last Update Date: | 11/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | 003818076 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |