Provider Demographics
NPI:1528469285
Name:STONE, TESSA DANIELLE (CNM)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:DANIELLE
Last Name:STONE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:DANIELLE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:5459 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6373
Mailing Address - Country:US
Mailing Address - Phone:707-304-1960
Mailing Address - Fax:
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA799586163W00000X
CA235678367A00000X
CO0997503367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528469285Medicaid