Healthcare Provider Details

I. General information

NPI: 1356557219
Provider Name (Legal Business Name): MARY C. STONER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 AUSTIN CENTER BLVD SPECIALLY FOR CHILDREN
AUSTIN TX
78731-3146
US

IV. Provider business mailing address

6811 AUSTIN CENTER BLVD SPECIALLY FOR CHILDREN
AUSTIN TX
78731-3146
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1850
  • Fax: 512-628-1851
Mailing address:
  • Phone: 512-628-1850
  • Fax: 512-628-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number229031
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number229031
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: