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General NPI Number Information
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NPI Number | 1649508763
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Entity Type | Individual
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Provider Name | JEREMIAH E STANLEY NP
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Gender | Male
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 5974 PENTZ RD
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City | PARADISE
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State | CA
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Zip | 95969-5509
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Country | US
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Telephone | 530-877-9361
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Fax |
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Provider Business Mailing Address
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Address Line | 3082 MCMURRAY DR
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City | ANDERSON
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State | CA
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Zip | 96007-3544
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Country | US
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Telephone | 530-365-4420
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Fax | 530-365-5186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 19056
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License Number State | CA
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