Provider Demographics
NPI:1043843642
Name:STEWART, PATRICIA NICOLE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:NICOLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4229 TELSTAR CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0742
Mailing Address - Country:US
Mailing Address - Phone:702-808-5741
Mailing Address - Fax:
Practice Address - Street 1:4229 TELSTAR CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0742
Practice Address - Country:US
Practice Address - Phone:702-808-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician