Active NPI
Marichelle Stoppenhagen, NP, RN, BSN
- Gerontology Clinical Nurse Specialist
- Costa Mesa, CA
National Provider Identifier
1174074348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Clinical Nurse Specialist
- License
- 95004393
- Practice address
- 711 W 17TH St
C2
Costa Mesa, CA 92627-4350 - Phone
- (917) 415-9851
- NPI assigned
- Oct 21, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Clinical Nurse Specialist | 364SG0600X | 95004393 | CA | Primary |
Addresses
Primary practice location
711 W 17TH St
C2
Costa Mesa, CA 92627-4350
Mailing address
711 W 17TH St
C2
Costa Mesa, CA 92627-4350
Phone (917) 415-9851
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95004393 | CA | MD | Gerontology Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477008000000",
"number": "1174074348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 W 17TH ST",
"address_2": "C2",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926274350",
"telephone_number": "917-415-9851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 W 17TH ST",
"address_2": "C2",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926274350",
"telephone_number": "917-415-9851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOPPENHAGEN",
"first_name": "MARICHELLE",
"credential": "NP, RN, BSN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-21",
"last_updated": "2016-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "364SG0600X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Gerontology",
"state": "CA",
"license": "95004393",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.