Provider Demographics
NPI:1013196641
Name:STANLEY, LISA M
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3443
Mailing Address - Country:US
Mailing Address - Phone:907-561-3313
Mailing Address - Fax:907-561-3315
Practice Address - Street 1:1750 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3443
Practice Address - Country:US
Practice Address - Phone:907-561-3313
Practice Address - Fax:907-561-3315
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator