Provider Demographics
NPI:1073603015
Name:STEWART, RENEE SANDRA (RD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:SANDRA
Last Name:STEWART
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:SANDRA
Other - Last Name:SMYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:RR 2 BOX 500TT
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058-9104
Mailing Address - Country:US
Mailing Address - Phone:610-871-8212
Mailing Address - Fax:
Practice Address - Street 1:471 CENTER ST
Practice Address - Street 2:KIDNEY TREATMENT CENTER OF PHILLIPSBURG - CKD SERVICES
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2663
Practice Address - Country:US
Practice Address - Phone:908-454-7440
Practice Address - Fax:908-454-9050
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA923321133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
097100QJYMedicare UPIN