MEDICARE: STONE OAK WOMENS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP132132	TX

General Provider Information

NPI Number	:	1538619440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONE OAK WOMENS CENTER

Provider Business Mailing Address
First Line	:	1139 E SONTERRA BLVD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1139 E SONTERRA BLVD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4349
Country	:	US
Telephone Number	:	210-614-2229
Fax Number	:

Authorized Official
Title or Position	:	MD - OBGYN
Name	:	MICHELLE HARDIN
Credential	:	MD
Telephone Number	:	210-614-2229

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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