Provider Demographics
NPI:1245430453
Name:STANLEY, DONNA R (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:R
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 RTE. 209
Mailing Address - Street 2:
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404
Mailing Address - Country:US
Mailing Address - Phone:845-626-0019
Mailing Address - Fax:
Practice Address - Street 1:4770 ROUTE 209
Practice Address - Street 2:
Practice Address - City:ACCORD
Practice Address - State:NY
Practice Address - Zip Code:12404-5738
Practice Address - Country:US
Practice Address - Phone:845-626-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088958-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02009447Medicaid