Provider Demographics
NPI:1942885751
Name:STANLEY, DIANA M
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:STANLEY
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 130
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25818-0130
Mailing Address - Country:US
Mailing Address - Phone:304-877-7041
Mailing Address - Fax:
Practice Address - Street 1:130 7TH STREET
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:WV
Practice Address - Zip Code:25818
Practice Address - Country:US
Practice Address - Phone:304-877-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker