Provider Demographics
NPI:1235439241
Name:BIALOSKI, STAN ADAM (NP)
Entity Type:Individual
Prefix:MR
First Name:STAN
Middle Name:ADAM
Last Name:BIALOSKI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 CROWN COLONY DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7729
Mailing Address - Country:US
Mailing Address - Phone:936-639-1526
Mailing Address - Fax:
Practice Address - Street 1:407 CROWN COLONY DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7729
Practice Address - Country:US
Practice Address - Phone:936-639-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558352363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology