Provider Demographics
NPI:1144478041
Name:STONER, CHARLES R (LPN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:STONER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 EIGHTH AVENUE
Mailing Address - Street 2:APARTMENT D2
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0507
Mailing Address - Country:US
Mailing Address - Phone:907-442-7903
Mailing Address - Fax:907-442-7932
Practice Address - Street 1:607 WOLVERINE DRIVE
Practice Address - Street 2:BOX 1073
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752
Practice Address - Country:US
Practice Address - Phone:907-442-7903
Practice Address - Fax:907-442-7932
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6215171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator