Provider Demographics
NPI:1477960441
Name:STEWART, MYRA FRANCINE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:FRANCINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 A 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603
Mailing Address - Country:US
Mailing Address - Phone:501-562-0278
Mailing Address - Fax:
Practice Address - Street 1:1611 92ND AVE
Practice Address - Street 2:A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-1509
Practice Address - Country:US
Practice Address - Phone:510-562-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA212403164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse