Provider Demographics
NPI:1285601575
Name:STANLEY, ELEANOR POWELL (MD)
Entity type:Individual
Prefix:
First Name:ELEANOR POWELL
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N 7TH ST
Mailing Address - Street 2:#225
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2754
Mailing Address - Country:US
Mailing Address - Phone:602-553-0440
Mailing Address - Fax:602-462-5588
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:#225
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-553-0440
Practice Address - Fax:602-462-5588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23047207VG0400X
NV10429207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG11398Medicare UPIN
AZ24877Medicare ID - Type Unspecified