Provider Demographics
NPI:1619156163
Name:STEWART, MARTHA LOUISE (NP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LOUISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MERRIMAC ST
Mailing Address - Street 2:RM. 420
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4724
Mailing Address - Country:US
Mailing Address - Phone:617-726-6370
Mailing Address - Fax:
Practice Address - Street 1:101 MERRIMAC ST
Practice Address - Street 2:RM. 420
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4724
Practice Address - Country:US
Practice Address - Phone:617-726-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129499363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health