Provider Demographics
NPI:1689750085
Name:STANLEY, LILLIAN JUNE (MSN FNP-C)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:JUNE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 GRAND AVE
Mailing Address - Street 2:CALIFORNIA POLYTECHNIC STATE UNIVERSITY HEALTH CENTER
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93410-9001
Mailing Address - Country:US
Mailing Address - Phone:805-756-1211
Mailing Address - Fax:805-756-5298
Practice Address - Street 1:1 GRAND AVE
Practice Address - Street 2:CALIFORNIA POLYTECHNIC STATE UNIVERSITY HEALTH CENTER
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93410-9001
Practice Address - Country:US
Practice Address - Phone:805-756-1211
Practice Address - Fax:805-756-5298
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP6713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner