Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | BS1011852 | PA |
NPI | 1861574154 |
---|---|
Provider Name | Dr. Christine Stanely |
First Address | Honesdale, PA 18431-7672 |
Second Address | Honesdale, PA 18431-7672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |