Provider Demographics
NPI:1538195136
Name:STANLEY, PATRICIA C (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:STANLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-553-0276
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-553-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12277363LP0808X
CARN525238163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP12277GMedicare ID - Type Unspecified
CAWNP12277CMedicare ID - Type Unspecified
CAWNP12277HMedicare PIN
CAP80757Medicare UPIN
CAWNP12277BMedicare ID - Type Unspecified
CAWNP12277FMedicare ID - Type Unspecified
CAWNP12277DMedicare ID - Type Unspecified
CAWNP12277EMedicare ID - Type Unspecified
CAW416Medicare PIN