Provider Demographics
NPI:1144682584
Name:SALVATORE, THERESA STONE (FNP-BC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:STONE
Last Name:SALVATORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2169
Mailing Address - Country:US
Mailing Address - Phone:928-289-4646
Mailing Address - Fax:
Practice Address - Street 1:26650 EUREKA RD
Practice Address - Street 2:STE C
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4835
Practice Address - Country:US
Practice Address - Phone:734-941-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704312744363LF0000X
AZAP10025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN188282OtherSTATE OF ARIZONA - RN
AZAP10025OtherARIZONA BOARD OF NURSING - NP
AZAP10025OtherARIZONA BOARD OF NURSING - NP