Provider Demographics
NPI:1962012872
Name:STANLEY, NATASHA LYNN
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:LYNN
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 1:914 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3801
Mailing Address - Country:US
Mailing Address - Phone:304-236-3426
Mailing Address - Fax:
Practice Address - Street 1:914 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3801
Practice Address - Country:US
Practice Address - Phone:304-236-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant