Individual
MARY ANN STANGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N. D
Contact information
Practice address
3728 N 3700 E, KIMBERLY, ID 83341-5087
(208) 420-4460
(208) 423-9007
Mailing address
3728 N 3700 E, KIMBERLY, ID 83341-5087
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
003818076
ID
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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