Provider Demographics
NPI:1508837154
Name:STONE-ARAVE, MARY (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STONE-ARAVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N 2ND ST STE 206
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6130
Mailing Address - Country:US
Mailing Address - Phone:208-342-2516
Mailing Address - Fax:208-342-1661
Practice Address - Street 1:222 N 2ND ST STE 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6130
Practice Address - Country:US
Practice Address - Phone:208-342-2516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID281363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13D0521509OtherCLIA LAB ID NUMBER
ID805192300Medicaid
IDNP-281AOtherIDAHO STATE LICENSE
HI000010139602OtherREGENCE BLUE SHIELD OF ID
IDNPXP6OtherBLUE CROSS OF IDAHO
IDN-14600OtherIDAHO STATE LICENSE