Provider Demographics
NPI:1457668790
Name:STEWART, JOLENE NICOLE (LMP)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:NICOLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8655
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-0655
Mailing Address - Country:US
Mailing Address - Phone:509-768-3635
Mailing Address - Fax:
Practice Address - Street 1:2517 S LAMONTE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2448
Practice Address - Country:US
Practice Address - Phone:509-768-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60175378225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist