Provider Demographics
NPI:1629675186
Name:STONE, GINA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:STONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:CASALE-RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1452 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2121
Mailing Address - Country:US
Mailing Address - Phone:847-832-1185
Mailing Address - Fax:
Practice Address - Street 1:1452 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2121
Practice Address - Country:US
Practice Address - Phone:847-832-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007572363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant