Basic Information
| Provider Information | |||||||||
| NPI: | 1730515743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANLEY | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1149 | ||||||||
| Address2: | |||||||||
| City: | NEBO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287610964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286593418 | ||||||||
| FaxNumber: | 8286593291 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 HWY 226 S | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287528741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286593418 | ||||||||
| FaxNumber: | 8286593291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2013 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 61855 | NC | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.