Provider Demographics
NPI:1801824222
Name:STONER, MARC CHARLES
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:CHARLES
Last Name:STONER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 CLOVEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1531
Mailing Address - Country:US
Mailing Address - Phone:120-952-9951
Mailing Address - Fax:
Practice Address - Street 1:190 S OAK AVE
Practice Address - Street 2:BUILDING 2 STE 1
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3528
Practice Address - Country:US
Practice Address - Phone:209-848-8410
Practice Address - Fax:209-848-0732
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6370163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 6370OtherMEDICAL LICENSE