Basic Information
Provider Information | |||||||||
NPI: | 1336523281 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STONE | ||||||||
FirstName: | EMILY | ||||||||
MiddleName: | KATHRYN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | C.N.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 16 W FALMOUTH HWY | ||||||||
Address2: | APT 24 | ||||||||
City: | FALMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 025403046 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3153827011 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 150 ANSEL HALLET RD | ||||||||
Address2: |   | ||||||||
City: | WEST YARMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 026732582 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5087718350 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/09/2015 | ||||||||
LastUpdateDate: | 07/27/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 686201-1 | NY | N |   | Nursing Service Providers | Registered Nurse |   | 363LP0200X | RN2305197 | MA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.