Provider Demographics
NPI:1376720003
Name:STEWART, DIANE BROCK (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:BROCK
Last Name:STEWART
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FOXFIRE LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-2012
Mailing Address - Country:US
Mailing Address - Phone:908-713-0420
Mailing Address - Fax:908-713-9752
Practice Address - Street 1:14 FOXFIRE LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-2012
Practice Address - Country:US
Practice Address - Phone:908-713-0420
Practice Address - Fax:908-713-9752
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00108900363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics