MEDICARE: LAURA L. STANLEY NP

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	363L00000X	Nurse Practitioner	101318	MA

General Provider Information

NPI Number	:	1891766481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L. STANLEY NP

Provider Business Mailing Address
First Line	:	1135 MORTON STREET
Second Line	:
City	:	MATTAPAN
State	:	MA
Zip	:	02126-2834
Country	:	US
Telephone Number	:	617-533-2300
Fax Number	:	617-533-2341

Provider Business Practice Location Address
First Line	:	1135 MORTON STREET
Second Line	:
City	:	MATTAPAN
State	:	MA
Zip	:	02126-2834
Country	:	US
Telephone Number	:	617-533-2400
Fax Number	:	617-533-2401

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	02/15/2012

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