Provider Demographics
NPI:1235785130
Name:STEWART, STEPHANIE LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-0229
Mailing Address - Country:US
Mailing Address - Phone:586-557-8442
Mailing Address - Fax:
Practice Address - Street 1:2095 RUSTIC TRAIL
Practice Address - Street 2:
Practice Address - City:ORTIONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-4846
Practice Address - Country:US
Practice Address - Phone:586-557-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health