Provider Demographics
NPI:1770008708
Name:STONE, BRENDLE CREWS
Entity Type:Individual
Prefix:
First Name:BRENDLE
Middle Name:CREWS
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 HODNETTS RD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-2070
Mailing Address - Country:US
Mailing Address - Phone:434-709-0626
Mailing Address - Fax:434-335-4992
Practice Address - Street 1:536 HODNETTS RD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557
Practice Address - Country:US
Practice Address - Phone:434-709-0626
Practice Address - Fax:434-335-4992
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60703790172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver