Provider Demographics
NPI:1972197705
Name:STALNAKER, CHARLES C
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:STALNAKER
Suffix:
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 1:85 FERN DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-7720
Mailing Address - Country:US
Mailing Address - Phone:304-269-4196
Mailing Address - Fax:
Practice Address - Street 1:85 FERN DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-7720
Practice Address - Country:US
Practice Address - Phone:304-269-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker