Individual
MR. JAY THOMAS STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
516 E, NIZHOM BLVD, GALLUP, NM 87301
(505) 722-1259
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
25931
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTHER
OTHER
AK
Enumeration date
05/11/2021
Last updated
05/11/2021
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