Healthcare Provider Details

I. General information

NPI: 1427465707
Provider Name (Legal Business Name): ERIKA STANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 WENDELL AVE
LEWISTOWN MT
59457-2261
US

IV. Provider business mailing address

536 NE WASHINGTON ST
LEWISTOWN MT
59457-2035
US

V. Phone/Fax

Practice location:
  • Phone: 406-535-7711
  • Fax:
Mailing address:
  • Phone: 406-535-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number70068
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: