Provider Demographics
NPI:1558546945
Name:GBNP, LLC
Entity type:Organization
Organization Name:GBNP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:419-868-1258
Mailing Address - Street 1:3521 BRIARFIELD BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9387
Mailing Address - Country:US
Mailing Address - Phone:419-868-1258
Mailing Address - Fax:419-868-9293
Practice Address - Street 1:3521 BRIARFIELD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9387
Practice Address - Country:US
Practice Address - Phone:419-868-1258
Practice Address - Fax:419-868-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========001OtherTRICARE NORTH
MO=========002OtherTRICARE NORTH
MO=========000OtherTRICARE NORTH
MO=========003OtherTRICARE NORTH
MO=========004OtherTRICARE NORTH
MO=========005OtherTRICARE NORTH
MO=========005OtherTRICARE NORTH