Healthcare Provider Details

I. General information

NPI: 1730585506
Provider Name (Legal Business Name): EUNICE STANBACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9060 MOONSHINE HOLW APT H
LAUREL MD
20723-1637
US

IV. Provider business mailing address

9060 MOONSHINE HOLW APT H
LAUREL MD
20723-1637
US

V. Phone/Fax

Practice location:
  • Phone: 410-300-6957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN1015835
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: