Provider Demographics
NPI:1346776598
Name:STEWART, SARAH ANNE (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:BACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:621 S. ERIE HWY
Mailing Address - Street 2:MODERN PSYCHIATRY & WELLNESS LLC
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:513-795-7557
Mailing Address - Fax:513-737-4603
Practice Address - Street 1:621 S. ERIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:513-795-7557
Practice Address - Fax:513-737-4603
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.458874163W00000X
OHPN.135370-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1346776598Medicaid