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NPI Code Detail

MEDICARE: MRS. MARY ELLIE STANKUS APRN, RN

MEDICARE: MRS. MARY ELLIE STANKUS APRN, RN
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
1363L00000XNurse Practitioner002831CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649222019
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ELLIE STANKUS APRN, RN
Provider Business Mailing Address
First Line : 67 DERBY AVE
Second Line :
City : DERBY
State : CT
Zip : 06418-1328
Country : US
Telephone Number : 203-732-1330
Fax Number : 203-732-1332
Provider Business Practice Location Address
First Line : 22 WESTFIELD AVE
Second Line :
City : ANSONIA
State : CT
Zip : 06401-1158
Country : US
Telephone Number : 203-736-9919
Fax Number : 855-212-4728
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 10/10/2018

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