Provider Demographics
NPI:1275776437
Name:STANLEY, ANGIE N (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:N
Last Name:STANLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190584
Mailing Address - Street 2:
Mailing Address - City:HAWI
Mailing Address - State:HI
Mailing Address - Zip Code:96719-0541
Mailing Address - Country:US
Mailing Address - Phone:808-731-9006
Mailing Address - Fax:808-374-4725
Practice Address - Street 1:65-1206 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7303
Practice Address - Country:US
Practice Address - Phone:808-731-9006
Practice Address - Fax:808-374-4725
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4041363LP0808X
KY3006007363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH14274OtherLICENSE