Provider Demographics
NPI:1508974320
Name:STEWART, PATRICIA L (CMA, CA, EMT-B)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:CMA, CA, EMT-B
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 2167
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1420
Mailing Address - Country:US
Mailing Address - Phone:208-305-8493
Mailing Address - Fax:
Practice Address - Street 1:320 11TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1914
Practice Address - Country:US
Practice Address - Phone:208-305-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID06461507374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide