Basic Information
| Provider Information | |||||||||
| NPI: | 1942405618 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANLEY | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | SHUE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6750 CAROLINA BLVD | ||||||||
| Address2: | |||||||||
| City: | CLYDE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287217052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286272211 | ||||||||
| FaxNumber: | 8286272216 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N JUSTICE ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286947687 | ||||||||
| FaxNumber: | 8286947638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2008-01577 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2008-01577 | 01 | NC | LICENSE | OTHER | NCA771C | 01 | NC | MEDICARE PTAN | OTHER |