Provider Demographics
NPI:1447566021
Name:STALEY, LEE G (RN)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:G
Last Name:STALEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:1870 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2873
Mailing Address - Country:US
Mailing Address - Phone:540-536-0110
Mailing Address - Fax:540-536-0154
Practice Address - Street 1:400 CAMPUS BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2873
Practice Address - Country:US
Practice Address - Phone:540-662-1108
Practice Address - Fax:540-450-2244
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2023-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024172929.363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily