1891758181 NPI number — MS. NANCY STALEY PA-C

Table of content: MS. NANCY STALEY PA-C (NPI 1891758181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891758181 NPI number — MS. NANCY STALEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STALEY
Provider First Name:
NANCY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1891758181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 CRESTVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERLY
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02891-2939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-832-7118
Provider Business Mailing Address Fax Number:
508-832-4758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 BEACH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERLY
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02891-2728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-475-9140
Provider Business Practice Location Address Fax Number:
401-475-9143
Provider Enumeration Date:
04/09/2006

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: 363AM0700X , with the licence number:  PA00286 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000027594 . This is a "BCBS RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 411588 . This is a "BLUE CHIP RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9004837 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290000286RI01 . This is a "ANTHEM CT" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 200286 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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