Provider Demographics
NPI:1760176846
Name:STANFIELD, THERESA MARIE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:STANFIELD
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:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-0144
Mailing Address - Country:US
Mailing Address - Phone:360-827-0072
Mailing Address - Fax:
Practice Address - Street 1:727 N TOWER AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4754
Practice Address - Country:US
Practice Address - Phone:360-827-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist