Healthcare Provider Details

I. General information

NPI: 1073972519
Provider Name (Legal Business Name): RHONDA STANLEY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S REYNOLDS RD STE C
TOLEDO OH
43615
US

IV. Provider business mailing address

115 S REYNOLDS RD STE C
TOLEDO OH
43615-6958
US

V. Phone/Fax

Practice location:
  • Phone: 419-725-6631
  • Fax:
Mailing address:
  • Phone: 419-725-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number4704312718
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: