Basic Information
| Provider Information | |||||||||
| NPI: | 1568975795 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIFIED HEALTH & WELLNESS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STANDING STONE FAMILY PRACTICE, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7243 SAWMILL RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430165005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143893814 | ||||||||
| FaxNumber: | 5143893841 | ||||||||
| Practice Location | |||||||||
| Address1: | 7243 SAWMILL RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430165005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143893814 | ||||||||
| FaxNumber: | 6143893841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2017 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MEYER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 6143893814 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 363LP0808X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | F0514404 | 01 | AANC BOARD CERTIFICATION - FAMILY NURSE PRACTITIONER | OTHER | 0257860 | 05 | OH | MEDICAID | 0104001 | 05 | OH | MEDICAID | 3587536 | 01 | OH | DEA | OTHER | APRN.CNP.15910 | 01 | OH | LICENSE | OTHER | 2013008374 | 01 | ANCC BOARD CERTIFICATION ADULT PSYCH MENTAL HEALTH NURSE PRACTITIONER | OTHER |