Provider Demographics
NPI:1184993206
Name:STANLEY, JENNIFER R
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1427
Mailing Address - Country:US
Mailing Address - Phone:304-372-1010
Mailing Address - Fax:304-372-4764
Practice Address - Street 1:368 MAIN ST W
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1427
Practice Address - Country:US
Practice Address - Phone:304-372-1010
Practice Address - Fax:304-372-4764
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2077-2332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist