Provider Demographics
NPI:1396847778
Name:STEWART, ROBERTA MARY (MSN RN FNP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:MARY
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSN RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3319
Mailing Address - Country:US
Mailing Address - Phone:757-399-0759
Mailing Address - Fax:757-399-3892
Practice Address - Street 1:3315 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3319
Practice Address - Country:US
Practice Address - Phone:757-399-0759
Practice Address - Fax:757-399-3892
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024057384363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
002210A15Medicare ID - Type Unspecified
P94543Medicare UPIN