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NPI Code Detail

MEDICARE: MS. CARROL LEA STANLEY III FOSTER MOTHER

MEDICARE: MS. CARROL LEA STANLEY III FOSTER MOTHER
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
1385H00000XRespite Care

General Provider Information

NPI Number : 1720263130
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CARROL LEA STANLEY III FOSTER MOTHER
Provider Business Mailing Address
First Line : 713 DEL HAVEN DR
Second Line :
City : DEL CITY
State : OK
Zip : 73115-2907
Country : US
Telephone Number : 405-672-2914
Fax Number : 405-672-2914
Provider Business Practice Location Address
First Line : 713 DEL HAVEN DR
Second Line :
City : DEL CITY
State : OK
Zip : 73115-2907
Country : US
Telephone Number : 405-672-2914
Fax Number : 405-672-2914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2008
Last Update Date : 01/03/2008

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