Provider Demographics
NPI:1740470392
Name:STANDLEY, MARTHA ANN (RN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:STANDLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 S CHEROKEE LN APT 76
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6365
Mailing Address - Country:US
Mailing Address - Phone:209-334-3028
Mailing Address - Fax:
Practice Address - Street 1:2807 HALIBUT POINT RD APT B
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9647
Practice Address - Country:US
Practice Address - Phone:209-966-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUR R 27349163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse