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General NPI Number Information
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NPI Number | 1124496872
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Entity Type | Organization
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Legal Business Name | STONE MEADOW HEALTH AND WELLNESS PC
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 204 MCCOLLUM ST SUITE 203
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City | LARAMIE
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State | WY
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Zip | 82070-5103
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Country | US
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Telephone | 307-745-8298
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Fax | 307-742-9468
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Provider Business Mailing Address
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Address Line | 204 MCCOLLUM ST SUITE 203
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City | LARAMIE
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State | WY
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Zip | 82070-5103
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Country | US
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Telephone | 307-745-8298
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLORIA STODDARD
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Credential | MS,FNP
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Telephone | 307-745-8298
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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 | 10494.0283
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License Number State | WY
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