Healthcare Provider Details

I. General information

NPI: 1891758181
Provider Name (Legal Business Name): NANCY STALEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BEACH ST
WESTERLY RI
02891-2728
US

IV. Provider business mailing address

25 CRESTVIEW DR
WESTERLY RI
02891-2939
US

V. Phone/Fax

Practice location:
  • Phone: 401-475-9140
  • Fax: 401-475-9143
Mailing address:
  • Phone: 508-832-7118
  • Fax: 508-832-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00286
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: