MEDICARE: MRS. DONNA R STANLEY LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	088958-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245430453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA R STANLEY LPN

Provider Business Mailing Address
First Line	:	4770 RTE. 209
Second Line	:
City	:	ACCORD
State	:	NY
Zip	:	12404
Country	:	US
Telephone Number	:	845-626-0019
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 ROUTE 209
Second Line	:
City	:	ACCORD
State	:	NY
Zip	:	12404-5738
Country	:	US
Telephone Number	:	845-626-0019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	07/25/2007

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