Provider Demographics
NPI:1639804727
Name:STEWART-AGER, FARANTE
Entity Type:Individual
Prefix:
First Name:FARANTE
Middle Name:
Last Name:STEWART-AGER
Suffix:
Gender:F
Credentials:
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 844
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2615
Mailing Address - Country:US
Mailing Address - Phone:843-476-8382
Mailing Address - Fax:
Practice Address - Street 1:2162 LANGFORDVILLE RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-3532
Practice Address - Country:US
Practice Address - Phone:843-476-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0OtherDOULA