Provider Demographics
NPI:1528822327
Name:STANAWAY, BETH ANNE-ROBERTS (FNP-C, MPH)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE-ROBERTS
Last Name:STANAWAY
Suffix:
Gender:F
Credentials:FNP-C, MPH
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2117 DEER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-3209
Mailing Address - Country:US
Mailing Address - Phone:906-250-3203
Mailing Address - Fax:
Practice Address - Street 1:850 W BARAGA AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4550
Practice Address - Country:US
Practice Address - Phone:906-449-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704361977163WG0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice