Provider Demographics
NPI:1265856637
Name:STONE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
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:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0855
Mailing Address - Country:US
Mailing Address - Phone:406-847-5095
Mailing Address - Fax:
Practice Address - Street 1:26 ASPEN LANE
Practice Address - Street 2:
Practice Address - City:HERON
Practice Address - State:MT
Practice Address - Zip Code:59844
Practice Address - Country:US
Practice Address - Phone:406-847-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program