Provider Demographics
NPI:1902984164
Name:STANLEY, CHRISTIAN WILSON (APN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIAN
Middle Name:WILSON
Last Name:STANLEY
Suffix:
Gender:F
Credentials:APN
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:JEFFERSON FACULTY PEDS AND DUPONT CHILDRENS HLTH PROG
Practice Address - Street 2:833 CHESTNUT STREET EAST SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4413
Practice Address - Country:US
Practice Address - Phone:215-955-7800
Practice Address - Fax:215-923-9383
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAUP005404N363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4042875Medicaid
NJ0024449Medicaid
078811SAJMedicare PIN
Q15367Medicare UPIN