1487981502 NPI number — DR. STANLEY F WANAT PHD POSTDOC BDCERTIF

Table of content: DR. STANLEY F WANAT PHD POSTDOC BDCERTIF (NPI 1487981502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487981502 NPI number — DR. STANLEY F WANAT PHD POSTDOC BDCERTIF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANAT
Provider First Name:
STANLEY
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD POSTDOC BDCERTIF
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487981502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 SANTA TERESA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94305-8011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-799-3344
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 SANTA TERESA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94305-8011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-799-3344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2009

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: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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