Provider Demographics
NPI:1083216857
Name:STEWART, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 LITTLE CACAPON LEVELS RD
Mailing Address - Street 2:
Mailing Address - City:POINTS
Mailing Address - State:WV
Mailing Address - Zip Code:25437-4508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3992 LITTLE CACAPON LEVELS RD
Practice Address - Street 2:
Practice Address - City:POINTS
Practice Address - State:WV
Practice Address - Zip Code:25437-4508
Practice Address - Country:US
Practice Address - Phone:304-261-6863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant