Provider Demographics
NPI:1437644895
Name:STEWART, INEZ KHADIJAH (LPN)
Entity Type:Individual
Prefix:
First Name:INEZ
Middle Name:KHADIJAH
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 LAIDLAW AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-5206
Mailing Address - Country:US
Mailing Address - Phone:513-322-9793
Mailing Address - Fax:
Practice Address - Street 1:1426 LAIDLAW AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-5206
Practice Address - Country:US
Practice Address - Phone:513-322-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168238164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse