Provider Demographics
NPI:1093021453
Name:STANLEY, JOHN CLIFFORD (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CLIFFORD
Last Name:STANLEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 HIGH STREET
Mailing Address - Street 2:P.O. BOX 192
Mailing Address - City:PLEASANT CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43772
Mailing Address - Country:US
Mailing Address - Phone:740-260-8816
Mailing Address - Fax:
Practice Address - Street 1:513 HIGH STREET
Practice Address - Street 2:
Practice Address - City:PLEASANT CITY
Practice Address - State:OH
Practice Address - Zip Code:43772
Practice Address - Country:US
Practice Address - Phone:740-260-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN133774MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse