Provider Demographics
NPI:1417269341
Name:STANLEY, LISA DAWN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DAWN
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 1:260 OLD JONES RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-4294
Mailing Address - Country:US
Mailing Address - Phone:731-627-0061
Mailing Address - Fax:
Practice Address - Street 1:1755 PARR AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2004
Practice Address - Country:US
Practice Address - Phone:731-627-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000079128163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse