Provider Demographics
NPI:1467497388
Name:STANLEY, GRAHAM N (CRNA)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:N
Last Name:STANLEY
Suffix:
Gender:M
Credentials:CRNA
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 711841
Mailing Address - Street 2:MID- ATLANTIC ANESTHESIA CONSULTANTS
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0001
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:304-720-8461
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:PLEASANT VALLEY HOSPITAL
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550
Practice Address - Country:US
Practice Address - Phone:304-674-2403
Practice Address - Fax:304-675-2240
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22005367500000X
OHNA00758367500000X
OH142485367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0067470000Medicaid
WV2122544OtherALLIANCE
WVDA0096OtherRR MEDICARE
OH2460484Medicaid
WV27005299700OtherWORKERS COMP
WV001721842OtherMSBCBS
WVP00185907OtherRR MEDICARE
WV001706470OtherMSBCBS
OH0752047Medicaid
WV0207026000Medicaid
WV270052997003OtherTRICARE
WV001721842OtherBCBS
WV55075562100OtherBRICKSTREET
WV8201243Medicare PIN
WV55075562100OtherBRICKSTREET