Provider Demographics
NPI:1689785842
Name:STANLEY, EDWARD PAUL (RN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:PAUL
Last Name:STANLEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4790 IRVINE BLVD
Mailing Address - Street 2:SUITE 105-355
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1973
Mailing Address - Country:US
Mailing Address - Phone:949-552-6266
Mailing Address - Fax:714-836-7034
Practice Address - Street 1:3500 BARRANCA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8226
Practice Address - Country:US
Practice Address - Phone:949-552-6266
Practice Address - Fax:714-836-7034
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286952163WG0000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACRNA 27940Other27940
CANURSE ANESTHESIAOther673
CARN286952Other286952