Provider Demographics
NPI:1629301692
Name:STEWART, REGINA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:ANN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-415-1475
Mailing Address - Fax:251-415-1476
Practice Address - Street 1:1720 CENTER ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3304
Practice Address - Country:US
Practice Address - Phone:251-415-1475
Practice Address - Fax:251-415-1476
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-065551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily