Provider Demographics
NPI:1982829065
Name:STONEHAM NANCE, AUDIENE M (DI)
Entity Type:Individual
Prefix:MS
First Name:AUDIENE
Middle Name:M
Last Name:STONEHAM NANCE
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-2139
Mailing Address - Country:US
Mailing Address - Phone:270-472-9515
Mailing Address - Fax:270-472-9519
Practice Address - Street 1:311 HOLMES ST
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2139
Practice Address - Country:US
Practice Address - Phone:270-472-9515
Practice Address - Fax:270-472-9519
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist