Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO03767 | |
N | 222Z00000X | Podiatrist | CPO03767 | |
Y | 224P00000X | Prosthetist | CPO03767 |
NPI | 1093316200 |
---|---|
Provider Name | Amy Stone |
First Address | Meridian, ID 83642-5906 |
Second Address | Meridian, ID 83642-5906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2020 |
Last Update Date | 04/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CPO03767 | AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS (01) |