Provider Demographics
NPI:1053032003
Name:STANLEY, ERICKA DAWN
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:DAWN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-1219
Mailing Address - Country:US
Mailing Address - Phone:304-299-3810
Mailing Address - Fax:
Practice Address - Street 1:405 E NORTH ST
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362-1219
Practice Address - Country:US
Practice Address - Phone:304-299-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant