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General NPI Number Information
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NPI Number | 1831681147
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Entity Type | Individual
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Provider Name | JONATHAN MITCHELL STONEMAN
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Gender | Male
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 875 PERIMETER DR # MS 2401
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City | MOSCOW
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State | ID
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Zip | 83844-9803
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Country | US
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Telephone | 208-921-1146
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Fax |
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Provider Business Mailing Address
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Address Line | 1945 E STAR LN
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City | MERIDIAN
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State | ID
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Zip | 83646-5561
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Country | US
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Telephone | 208-921-1146
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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