Healthcare Provider Details

I. General information

NPI: 1134313125
Provider Name (Legal Business Name): ERYN AMALIA CAAMANO STANSFIELD M.D., MOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2007
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7238 6TH ST BLDG 249
HILL AFB UT
84056-5213
US

IV. Provider business mailing address

7238 6TH ST BLDG 249
HILL AFB UT
84056-5213
US

V. Phone/Fax

Practice location:
  • Phone: 801-231-9559
  • Fax:
Mailing address:
  • Phone: 801-231-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number233786
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: