Provider Demographics
NPI:1861571739
Name:STONE, GWENDOLYN LORETTA (LVN)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:LORETTA
Last Name:STONE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14328 W RAVINE RUN
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-7414
Mailing Address - Country:US
Mailing Address - Phone:281-802-9523
Mailing Address - Fax:
Practice Address - Street 1:14328 W RAVINE RUN
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-7414
Practice Address - Country:US
Practice Address - Phone:281-802-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX080351164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse