Provider Demographics
NPI:1407637713
Name:STEWART, ANITRA RENEE (NA)
Entity Type:Individual
Prefix:
First Name:ANITRA
Middle Name:RENEE
Last Name:STEWART
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15052 SNOWDEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3648
Mailing Address - Country:US
Mailing Address - Phone:313-758-1375
Mailing Address - Fax:
Practice Address - Street 1:15052 SNOWDEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3648
Practice Address - Country:US
Practice Address - Phone:313-758-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI376K00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide