Provider Demographics
NPI:1427414929
Name:STEWART, TWANNA CHANNEL (RN)
Entity Type:Individual
Prefix:
First Name:TWANNA
Middle Name:CHANNEL
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 POE AVE APT A1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-1552
Mailing Address - Country:US
Mailing Address - Phone:202-819-8733
Mailing Address - Fax:
Practice Address - Street 1:51 POE AVE APT A1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-1552
Practice Address - Country:US
Practice Address - Phone:202-819-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY765625163WH0200X
NY325226164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse