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General NPI Number Information
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NPI Number | 1053543660
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Entity Type | Individual
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Provider Name | BROOKNEY R STONE FNP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 790 W USTICK RD STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-5558
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Country | US
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Telephone | 208-639-3990
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Fax | 208-639-3992
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Provider Business Mailing Address
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Address Line | PO BOX 336
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City | EAGLE
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State | ID
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Zip | 83616-0336
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Country | US
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Telephone | 208-639-3990
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Fax | 208-639-3992
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-923A
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License Number State | ID
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