Provider Demographics
NPI:1407388465
Name:STONEM, ELYSIA L (MSN, AG-ACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ELYSIA
Middle Name:L
Last Name:STONEM
Suffix:
Gender:F
Credentials:MSN, AG-ACNP-BC
Other - Prefix:
Other - First Name:ELYSIA
Other - Middle Name:LYNN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:14624 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1802
Mailing Address - Country:US
Mailing Address - Phone:304-413-3183
Mailing Address - Fax:
Practice Address - Street 1:30 MON HEALTH DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2853
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:337-943-0846
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001239593163W00000X
NC5017720363LA2100X
VA0024174282363LA2100X
WV96841363LA2100X
WAAP61144182363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2179988Medicaid