Provider Demographics
NPI:1063455947
Name:STONE, LUDONNA K (CRNA, MHS)
Entity Type:Individual
Prefix:
First Name:LUDONNA
Middle Name:K
Last Name:STONE
Suffix:
Gender:F
Credentials:CRNA, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-5059
Mailing Address - Country:US
Mailing Address - Phone:307-745-8529
Mailing Address - Fax:307-745-8529
Practice Address - Street 1:3508 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-5059
Practice Address - Country:US
Practice Address - Phone:307-745-8529
Practice Address - Fax:307-745-8529
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY21072.183367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312322OtherBLUE CROSS BLUE SHIELD
NE10024962200Medicaid
WY117576900Medicaid
WYP00060768Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WYW9775Medicare ID - Type Unspecified
WYS31311Medicare UPIN