Provider Demographics
NPI:1982797239
Name:PATHWAYS NURSING PRACTITIONERS, INC.
Entity Type:Organization
Organization Name:PATHWAYS NURSING PRACTITIONERS, INC.
Other - Org Name:PATHWAY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:209-848-8410
Mailing Address - Street 1:190 S OAK AVE
Mailing Address - Street 2:BLDG. 2-1
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3528
Mailing Address - Country:US
Mailing Address - Phone:209-848-8410
Mailing Address - Fax:209-848-0732
Practice Address - Street 1:190 S OAK AVE
Practice Address - Street 2:BLDG.2-1
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS31209Medicare UPIN