Provider Demographics
NPI:1720630197
Name:STALIANS, JAMES DEAN (AGNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DEAN
Last Name:STALIANS
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:MRS
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:STALIANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGNP
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:866-682-4842
Mailing Address - Fax:
Practice Address - Street 1:1540 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4430
Practice Address - Country:US
Practice Address - Phone:866-682-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452145163WG0600X
CA95010123363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health