Healthcare Provider Details

I. General information

NPI: 1326186388
Provider Name (Legal Business Name): CAROLYN BRIGITTE STONEMARK WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

5402 S BLACK FALLS DR
TUCSON AZ
85747-6087
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-6010
  • Fax:
Mailing address:
  • Phone: 520-344-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number265
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: