Provider Demographics
NPI:1790386449
Name:NEVELS, STANLEY JR
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:NEVELS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1159
Mailing Address - Country:US
Mailing Address - Phone:815-573-7232
Mailing Address - Fax:
Practice Address - Street 1:314 INDIANA ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1159
Practice Address - Country:US
Practice Address - Phone:815-573-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic