Provider Demographics
NPI:1093756124
Name:STEWART, HEIDI C (CRNA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:C
Last Name:STEWART
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8661
Mailing Address - Country:US
Mailing Address - Phone:304-685-9404
Mailing Address - Fax:
Practice Address - Street 1:1255 PINEVIEW DR
Practice Address - Street 2:REGIONAL EYE ASSOCIATES
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2738
Practice Address - Country:US
Practice Address - Phone:304-598-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32959367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0067743000Medicaid
WV0067743000Medicaid
WV001324757OtherMOUNTAIN STATE BCBS OF WV
WV8207215Medicare PIN
WV9333201Medicare PIN
WV1046341OtherBRICKSTREET INDIVIDUAL
WVDA0096OtherRR MEDICARE
WV001706470OtherMSBCBS GROUP
WV27005299701OtherBRICKSTREET
WV270052997004OtherTRICARE
WVP00142951OtherRR MEDICARE