Provider Demographics
NPI:1457470619
Name:STANSBURY, COLLEEN IRENE (P A)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:IRENE
Last Name:STANSBURY
Suffix:
Gender:F
Credentials:P A
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 145
Mailing Address - Street 2:
Mailing Address - City:GUSTAVUS
Mailing Address - State:AK
Mailing Address - Zip Code:99826-0145
Mailing Address - Country:US
Mailing Address - Phone:907-697-2771
Mailing Address - Fax:
Practice Address - Street 1:11120 GLACIER HWY
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8625
Practice Address - Country:US
Practice Address - Phone:907-796-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK352363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical