Provider Demographics
NPI:1093318446
Name:STANLEY, REBECCA LYNN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
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 1:8562 CABIN CREEK RD.
Mailing Address - Street 2:
Mailing Address - City:ESKDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25075
Mailing Address - Country:US
Mailing Address - Phone:304-549-9927
Mailing Address - Fax:
Practice Address - Street 1:8562 CABIN CREEK RD.
Practice Address - Street 2:
Practice Address - City:ESKDALE
Practice Address - State:WV
Practice Address - Zip Code:25075
Practice Address - Country:US
Practice Address - Phone:304-549-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant