Provider Demographics
NPI:1174698955
Name:STANISH, CARMEN EMILIA (REGISTERED NURSE08)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:EMILIA
Last Name:STANISH
Suffix:
Gender:F
Credentials:REGISTERED NURSE08
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2316
Mailing Address - Country:US
Mailing Address - Phone:714-834-8752
Mailing Address - Fax:714-834-7956
Practice Address - Street 1:PDS 1725 W. 17TH ST.
Practice Address - Street 2:101E
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706
Practice Address - Country:US
Practice Address - Phone:714-834-8752
Practice Address - Fax:714-834-7956
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN363380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse