Provider Demographics
NPI:1952574824
Name:STANLEY, TERESA MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:271 FORT RICHARDSON AVE
Mailing Address - Street 2:BLDG 1001
Mailing Address - City:GOODFELLOW AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76908-4901
Mailing Address - Country:US
Mailing Address - Phone:210-845-9912
Mailing Address - Fax:
Practice Address - Street 1:271 FORT RICHARDSON AVE
Practice Address - Street 2:BLDG 1001
Practice Address - City:GOODFELLOW AFB
Practice Address - State:TX
Practice Address - Zip Code:76908-4901
Practice Address - Country:US
Practice Address - Phone:210-845-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical