MEDICARE: MRS. TRICIA L STANLEY NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	71000752	IN

General Provider Information

NPI Number	:	1376578435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRICIA L STANLEY NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1615 US HWY 231 S
Second Line	:	SUITE A
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-4603
Country	:	US
Telephone Number	:	765-323-4689
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 US HWY 231 S
Second Line	:	SUITE A
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-4603
Country	:	US
Telephone Number	:	765-323-4689
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	09/08/2022

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