Provider Demographics
NPI:1407410251
Name:STEWART, VANESSA (LVN)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 SAGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-7989
Mailing Address - Country:US
Mailing Address - Phone:760-510-3197
Mailing Address - Fax:760-510-3197
Practice Address - Street 1:1680 SAGEWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-7989
Practice Address - Country:US
Practice Address - Phone:760-510-3197
Practice Address - Fax:760-510-3197
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194195164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty