Provider Demographics
NPI:1578130779
Name:STANLEY, ANNE ELIZABETH
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BLAKESLEE AVE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1692
Mailing Address - Country:US
Mailing Address - Phone:567-239-4171
Mailing Address - Fax:
Practice Address - Street 1:127 BLAKESLEE AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1692
Practice Address - Country:US
Practice Address - Phone:567-239-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029279363LP0808X
OHRN.381387163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse