Provider Demographics
NPI:1952344319
Name:STANLEY, JOAN MARLENE (CRNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARLENE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8769
Mailing Address - Fax:410-328-3577
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-8769
Practice Address - Fax:410-328-3577
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR046532363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD606877-01OtherBLUE CROSS/BLUE SHIELD
MD620501100Medicaid
MD418028300Medicaid
MD620501100Medicaid
MD606877-01OtherBLUE CROSS/BLUE SHIELD
P01072Medicare UPIN