Provider Demographics
NPI:1194971283
Name:STONE, MARTHA R (RN, ANP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:R
Last Name:STONE
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:R
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, ANP
Mailing Address - Street 1:348 JUNIPERO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2234
Mailing Address - Country:US
Mailing Address - Phone:240-355-7977
Mailing Address - Fax:301-652-7977
Practice Address - Street 1:8898 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1147
Practice Address - Country:US
Practice Address - Phone:858-715-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR123106363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner