Provider Demographics
NPI:1538317417
Name:STANDFILL, JANA MARIE
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:MARIE
Last Name:STANDFILL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JANA
Other - Middle Name:MARIE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1725 JACKSON DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8608
Practice Address - Country:US
Practice Address - Phone:501-658-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist