Provider Demographics
NPI:1942703319
Name:STANBACK, WHITNEY MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MARIE
Last Name:STANBACK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 LAVIN PLZ
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-1602
Mailing Address - Country:US
Mailing Address - Phone:414-213-1692
Mailing Address - Fax:
Practice Address - Street 1:1820 LAVIN PLZ
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-1602
Practice Address - Country:US
Practice Address - Phone:414-213-1692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI327178164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse