Provider Demographics
NPI:1609005792
Name:EWERT, STEFANIE STELLFOX (RN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:STELLFOX
Last Name:EWERT
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 1:6849 S STAFF RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2029 VALLEYGATE DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-323-2103
Practice Address - Fax:910-323-2219
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127596163W00000X, 163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127596OtherREGISTER NURSE LICENSE