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General NPI Number Information
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NPI Number | 1730998782
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Entity Type | Individual
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Provider Name | ELIVE M STANLY
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Gender | Male
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2703 FORT BAKER DR SE APT 1
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City | WASHINGTON
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State | DC
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Zip | 20020-7274
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Country | US
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Telephone | 240-244-4863
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Fax | 443-513-2664
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Provider Business Mailing Address
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Address Line | 9950 W INDIAN SCHOOL RD UNIT 8
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City | PHOENIX
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State | AZ
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Zip | 85037-5912
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Country | US
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Telephone | 443-527-1423
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Fax |
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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 | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 966854
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CN221201831
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License Number State | DC
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