MEDICARE: DEVIN LEAH STANIAR PA

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	363A00000X	Physician Assistant	2258	CO

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	:	1972682714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN LEAH STANIAR PA

Provider Business Mailing Address
First Line	:	2930 11TH AVE
Second Line	:
City	:	EVANS
State	:	CO
Zip	:	80620-1011
Country	:	US
Telephone Number	:	970-353-9403
Fax Number	:	970-353-9906

Provider Business Practice Location Address
First Line	:	302 3RD ST SE
Second Line	:	SUITE 150
City	:	LOVELAND
State	:	CO
Zip	:	80537-6419
Country	:	US
Telephone Number	:	970-669-4855
Fax Number	:	970-669-7389

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	03/06/2014

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Directions to “ DEVIN LEAH STANIAR PA” Practice Location

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