Provider Demographics
NPI:1417156456
Name:STEWART, NORA MARIE (MAF-AAA)
Entity Type:Individual
Prefix:MRS
First Name:NORA
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MAF-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 LAKE AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5428
Mailing Address - Country:US
Mailing Address - Phone:260-485-1231
Mailing Address - Fax:260-486-6958
Practice Address - Street 1:3030 LAKE AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5428
Practice Address - Country:US
Practice Address - Phone:260-485-1231
Practice Address - Fax:260-486-6958
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002246A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN177070BMedicare PIN
INP23437Medicare UPIN