Provider Demographics
NPI:1053765552
Name:STANLEY, RICHARD (RN-BSN)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:STANLEY
Suffix:
Gender:M
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1157
Mailing Address - Country:US
Mailing Address - Phone:801-960-2783
Mailing Address - Fax:
Practice Address - Street 1:3473 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1157
Practice Address - Country:US
Practice Address - Phone:801-960-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7990849-3102163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7990849-3101OtherLPN