Healthcare Provider Details

I. General information

NPI: 1639702996
Provider Name (Legal Business Name): AMBERLY RENEE STANFILL MA, EKG TECH, BST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY RENEE STANFILL MA, EKG TECH

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 E FLAMINGO RD STE 273
LAS VEGAS NV
89119-0802
US

IV. Provider business mailing address

2235 E FLAMINGO RD STE 273
LAS VEGAS NV
89119-0802
US

V. Phone/Fax

Practice location:
  • Phone: 725-204-7591
  • Fax: 702-920-8493
Mailing address:
  • Phone: 725-204-7591
  • Fax: 702-920-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: