Healthcare Provider Details

I. General information

NPI: 1093021453
Provider Name (Legal Business Name): JOHN CLIFFORD STANLEY LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 HIGH STREET
PLEASANT CITY OH
43772
US

IV. Provider business mailing address

513 HIGH STREET P.O. BOX 192
PLEASANT CITY OH
43772
US

V. Phone/Fax

Practice location:
  • Phone: 740-260-8816
  • Fax:
Mailing address:
  • Phone: 740-260-8816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN133774MEDS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: