Provider Demographics
NPI:1790321453
Name:STANCIL, KATRICE M
Entity Type:Individual
Prefix:MRS
First Name:KATRICE
Middle Name:M
Last Name:STANCIL
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 1:501 VIKING DR UNIT 8302
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23450-1259
Mailing Address - Country:US
Mailing Address - Phone:757-768-5856
Mailing Address - Fax:
Practice Address - Street 1:864 CRASHAW ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6916
Practice Address - Country:US
Practice Address - Phone:757-768-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor