Provider Demographics
NPI:1982022273
Name:KATHERINE R STANLEY
Entity Type:Organization
Organization Name:KATHERINE R STANLEY
Other - Org Name:ELEGANT PROFILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:336-331-3480
Mailing Address - Street 1:2830 MAPLEWOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4114
Mailing Address - Country:US
Mailing Address - Phone:336-331-3480
Mailing Address - Fax:336-793-1218
Practice Address - Street 1:2830 MAPLEWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4114
Practice Address - Country:US
Practice Address - Phone:336-331-3480
Practice Address - Fax:336-793-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty