Provider Demographics
NPI:1346769742
Name:STEWARD, JEREMY (CRNP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:STEWARD
Suffix:
Gender:M
Credentials:CRNP
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 1671
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1671
Mailing Address - Country:US
Mailing Address - Phone:240-964-8921
Mailing Address - Fax:240-964-8922
Practice Address - Street 1:1050 W INDUSTRIAL BLVD STE 17
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4331
Practice Address - Country:US
Practice Address - Phone:240-964-9300
Practice Address - Fax:240-964-9310
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104172363L00000X
MDR193830363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty