Provider Demographics
NPI:1528301355
Name:STANTON, LYNDA GAYLE
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:GAYLE
Last Name:STANTON
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 1:12552 NE KING RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OK
Mailing Address - Zip Code:73541-5250
Mailing Address - Country:US
Mailing Address - Phone:580-574-9225
Mailing Address - Fax:
Practice Address - Street 1:12552 NE KING RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:OK
Practice Address - Zip Code:73541-5250
Practice Address - Country:US
Practice Address - Phone:580-574-9225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor