Provider Demographics
NPI:1164922522
Name:STEWART, LEAH MARIE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:LEAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:106 DUEVER ST
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-3406
Mailing Address - Country:US
Mailing Address - Phone:309-202-3062
Mailing Address - Fax:
Practice Address - Street 1:335 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-3644
Practice Address - Country:US
Practice Address - Phone:309-202-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041347263163W00000X
IL209017485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse