Provider Demographics
NPI:1467437418
Name:STANKO, JEAN F (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:F
Last Name:STANKO
Suffix:
Gender:F
Credentials:CRNP
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 700
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-0700
Mailing Address - Country:US
Mailing Address - Phone:256-237-8527
Mailing Address - Fax:256-237-0208
Practice Address - Street 1:400 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5754
Practice Address - Country:US
Practice Address - Phone:256-237-8527
Practice Address - Fax:256-237-0208
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1053066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000029315Medicaid
AL051029315OtherBCBS
AL051029315OtherBCBS
AL000029315Medicare ID - Type Unspecified