Provider Demographics
NPI:1164456257
Name:STALEY, AURELIA LOUISE (CFNP)
Entity Type:Individual
Prefix:MISS
First Name:AURELIA
Middle Name:LOUISE
Last Name:STALEY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2857
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557
Mailing Address - Country:US
Mailing Address - Phone:505-751-4689
Mailing Address - Fax:505-289-3648
Practice Address - Street 1:6349 HIGHWAY 550
Practice Address - Street 2:CHECKERBOARD AREA HEALTH SYSTEM
Practice Address - City:CUBA
Practice Address - State:NM
Practice Address - Zip Code:87013
Practice Address - Country:US
Practice Address - Phone:505-289-3291
Practice Address - Fax:505-289-3648
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR31793363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ0165Medicaid
NMQ0165Medicaid