Provider Demographics
NPI:1366683245
Name:STONE, CARLIE ANNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:CARLIE
Middle Name:ANNE
Last Name:STONE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 MORMON COULEE RD APT 122
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-8270
Mailing Address - Country:US
Mailing Address - Phone:906-364-4847
Mailing Address - Fax:
Practice Address - Street 1:4445 MORMON COULEE RD APT 122
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-8270
Practice Address - Country:US
Practice Address - Phone:906-364-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165358-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse