Provider Demographics
NPI:1629322516
Name:STEWART, OCTAVIA ORA (RN)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:ORA
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:OCTAVIA
Other - Middle Name:ORA
Other - Last Name:SESSION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:854 BRANDY CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214-3941
Mailing Address - Country:US
Mailing Address - Phone:205-529-4228
Mailing Address - Fax:
Practice Address - Street 1:854 BRANDY CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-3941
Practice Address - Country:US
Practice Address - Phone:205-529-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse