Provider Demographics
NPI:1770816878
Name:INLAY, STANLEY RICKY (LVN)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:RICKY
Last Name:INLAY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:RICKY
Other - Last Name:INLAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:6637 24TH ST
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-3805
Mailing Address - Country:US
Mailing Address - Phone:916-628-2378
Mailing Address - Fax:
Practice Address - Street 1:7548 WHISPERWILLOW DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-4170
Practice Address - Country:US
Practice Address - Phone:916-628-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN165599164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse