MEDICARE: ERIK J STANLEY EMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146N00000X	Basic Emergency Medical Technician

General Provider Information

NPI Number	:	1225575384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK J STANLEY EMT

Provider Business Mailing Address
First Line	:	6730 SE SKYCREST LN
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-8787
Country	:	US
Telephone Number	:	360-871-2458
Fax Number	:

Provider Business Practice Location Address
First Line	:	6730 SE SKYCREST LN
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-8787
Country	:	US
Telephone Number	:	360-871-2458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	01/27/2017

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