Provider Demographics
NPI:1174074348
Name:STOPPENHAGEN, MARICHELLE (NP, RN, BSN)
Entity type:Individual
Prefix:
First Name:MARICHELLE
Middle Name:
Last Name:STOPPENHAGEN
Suffix:
Gender:F
Credentials:NP, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 17TH ST
Mailing Address - Street 2:C2
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4350
Mailing Address - Country:US
Mailing Address - Phone:917-415-9851
Mailing Address - Fax:
Practice Address - Street 1:711 W 17TH ST
Practice Address - Street 2:C2
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4350
Practice Address - Country:US
Practice Address - Phone:917-415-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004393364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology