Provider Demographics
NPI:1053461582
Name:STANCIL, DONNA L (LAC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:STANCIL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61158 CHUCKANUT DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9061
Mailing Address - Country:US
Mailing Address - Phone:541-312-2933
Mailing Address - Fax:
Practice Address - Street 1:740 NW COLORADO AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3291
Practice Address - Country:US
Practice Address - Phone:541-388-4822
Practice Address - Fax:541-388-4805
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORACOO580171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist