Provider Demographics
NPI:1184202418
Name:STEWART, CHRISTINE JOANNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JOANNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MCGINNIS WAY
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442
Mailing Address - Country:US
Mailing Address - Phone:785-240-7142
Mailing Address - Fax:785-240-6047
Practice Address - Street 1:670 WARRIOR DR RM 148
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-2759
Practice Address - Country:US
Practice Address - Phone:785-240-7142
Practice Address - Fax:785-240-6047
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-80539163W00000X
KS1184202418163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS13-80539OtherKANSAS STATE BOARD OF NURSING
KS1184202418Medicaid