Provider Demographics
NPI:1376578435
Name:STANLEY, TRICIA L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:L
Last Name:STANLEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1615 US HWY 231 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-4603
Mailing Address - Country:US
Mailing Address - Phone:765-323-4689
Mailing Address - Fax:
Practice Address - Street 1:1615 US HWY 231 S
Practice Address - Street 2:SUITE A
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-4603
Practice Address - Country:US
Practice Address - Phone:765-323-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000752363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner