Provider Demographics
NPI:1982609475
Name:STANLEY, VONDA T (FNP)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:T
Last Name:STANLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1906
Mailing Address - Country:US
Mailing Address - Phone:434-447-6969
Mailing Address - Fax:434-447-2240
Practice Address - Street 1:514 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1906
Practice Address - Country:US
Practice Address - Phone:434-447-6969
Practice Address - Fax:434-447-2240
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024116223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7000902OtherNC MEDICAID
VA010105030OtherVA PREMIER KB
VAP00255169OtherSH RR MEDICARE
VA010004900Medicaid
VA010004900OtherVA PREMIER
VA010259541Medicaid
VA010105030Medicaid
VA187681OtherMEDCOST KB
VA010105030OtherVA PREMIER KB
VA010004900Medicaid
VA187681OtherMEDCOST KB
VAS66693Medicare UPIN
VA010259541Medicaid
VA493869Medicare Oscar/Certification
VA010004900OtherVA PREMIER