Provider Demographics
NPI:1699843920
Name:STONE, TERESA VALERIE ANNIE (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:VALERIE ANNIE
Last Name:STONE
Suffix:
Gender:F
Credentials:FNP
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 1520
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058
Mailing Address - Country:US
Mailing Address - Phone:541-296-7677
Mailing Address - Fax:541-296-7206
Practice Address - Street 1:1810 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058
Practice Address - Country:US
Practice Address - Phone:541-296-7677
Practice Address - Fax:541-296-7206
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218103Medicaid
OR383996Medicare Oscar/Certification
S97622Medicare UPIN
OR383994Medicare Oscar/Certification