Provider Demographics
NPI:1164298063
Name:STONE, SIERRA CHRISTINA
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:CHRISTINA
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3096 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3650
Mailing Address - Country:US
Mailing Address - Phone:612-396-6410
Mailing Address - Fax:
Practice Address - Street 1:3096 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-3650
Practice Address - Country:US
Practice Address - Phone:612-396-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2023-00447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist