Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 106983 | WV |
N | 363LP2300X | Nurse Practitioner - Primary Care | 106983 | WV |
NPI | 1750995734 |
---|---|
Provider Name | Sarah Nicole Stanley |
First Address | Beckley, WV 25801-2653 |
Second Address | Beckley, WV 25801-2653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2020 |
Last Update Date | 14/10/2021 |