Provider Demographics
NPI:1033385166
Name:SEVERO-STEWART, MARJORIE (CRNP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:SEVERO-STEWART
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 LIBERTY ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2566
Mailing Address - Country:US
Mailing Address - Phone:814-336-6384
Mailing Address - Fax:814-336-1372
Practice Address - Street 1:765 LIBERTY ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-336-6384
Practice Address - Fax:814-336-1372
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004280D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics