Healthcare Provider Details

I. General information

NPI: 1164488755
Provider Name (Legal Business Name): KATHERINE R STANLEY CFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 MAPLEWOOD AVE STE A
WINSTON SALEM NC
27103-4114
US

IV. Provider business mailing address

2830 MAPLEWOOD AVE STE A
WINSTON SALEM NC
27103-4114
US

V. Phone/Fax

Practice location:
  • Phone: 336-331-3480
  • Fax: 336-793-1218
Mailing address:
  • Phone: 336-331-3480
  • Fax: 336-793-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number23483
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: