Provider Demographics
NPI:1467634824
Name:STANLEY, JOEY LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:LYNN
Last Name:STANLEY
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 1:130 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE H321
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3121
Mailing Address - Country:US
Mailing Address - Phone:484-337-4097
Mailing Address - Fax:484-337-4082
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:SUITE H321
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-4097
Practice Address - Fax:484-337-4082
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143419XRUMedicare PIN