Provider Demographics
NPI:1124496872
Name:STONE MEADOW HEALTH AND WELLNESS PC
Entity type:Organization
Organization Name:STONE MEADOW HEALTH AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS,FNP
Authorized Official - Phone:307-745-8298
Mailing Address - Street 1:204 MCCOLLUM ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5103
Mailing Address - Country:US
Mailing Address - Phone:307-745-8298
Mailing Address - Fax:
Practice Address - Street 1:204 MCCOLLUM ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5103
Practice Address - Country:US
Practice Address - Phone:307-745-8298
Practice Address - Fax:307-742-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10494.0283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty