1457393514 NPI number — DR. ADRIENNE M STANLEY D.O.

Table of content: DR. ADRIENNE M STANLEY D.O. (NPI 1457393514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457393514 NPI number — DR. ADRIENNE M STANLEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANLEY
Provider First Name:
ADRIENNE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAESANO
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457393514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28711 8 MILE RD
Provider Second Line Business Mailing Address:
C/O COMPREHENSIVE OBGYN
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48152-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-474-4590
Provider Business Mailing Address Fax Number:
248-888-9127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28711 8 MILE RD
Provider Second Line Business Practice Location Address:
C/O COMPREHENSIVE OBGYN
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48152-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-474-4590
Provider Business Practice Location Address Fax Number:
248-888-9127
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  5101013976 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4732646 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1658212135 . This is a "BLUE CROSS ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4732655 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16903 . This is a "MCARE ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7729497 . This is a "AETNA ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 140563 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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