Provider Demographics
NPI:1164628475
Name:STEWART, CARLA DIANE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:DIANE
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25837 OAK ST
Mailing Address - Street 2:#228
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3156
Mailing Address - Country:US
Mailing Address - Phone:310-962-9813
Mailing Address - Fax:
Practice Address - Street 1:25837 OAK ST
Practice Address - Street 2:#228
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3156
Practice Address - Country:US
Practice Address - Phone:310-962-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504098363LF0000X
CA9972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily