Provider Demographics
NPI:1548496680
Name:STANBACK, KANIKA JANELLE (RT)
Entity type:Individual
Prefix:
First Name:KANIKA
Middle Name:JANELLE
Last Name:STANBACK
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 YANCEYVILLE ST
Mailing Address - Street 2:APT E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4795
Mailing Address - Country:US
Mailing Address - Phone:336-987-9477
Mailing Address - Fax:252-355-7358
Practice Address - Street 1:3116 YANCEYVILLE ST
Practice Address - Street 2:APT E
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4795
Practice Address - Country:US
Practice Address - Phone:336-997-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5365227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified