Provider Demographics
NPI:1205193596
Name:STANLEY, AMANDA REBEKAH (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:REBEKAH
Last Name:STANLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 STALLINGS RD APT B
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1477
Mailing Address - Country:US
Mailing Address - Phone:770-833-1344
Mailing Address - Fax:
Practice Address - Street 1:2 LEE ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1915
Practice Address - Country:US
Practice Address - Phone:770-486-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse