Provider Demographics
NPI:1184774242
Name:STONE, LINDA ANN (PHD RNC APNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:STONE
Suffix:
Gender:F
Credentials:PHD RNC APNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:FULKERSON
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD RNC APNP
Mailing Address - Street 1:2920 S WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2512
Mailing Address - Country:US
Mailing Address - Phone:414-744-6333
Mailing Address - Fax:
Practice Address - Street 1:13965 W BURLEIGH RD
Practice Address - Street 2:STE 103
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3064
Practice Address - Country:US
Practice Address - Phone:262-785-1404
Practice Address - Fax:262-785-1409
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1458 033363L00000X
WI2814 - 057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43898400Medicaid