Provider Demographics
NPI:1689281743
Name:STEWARD, EDDIE LEE
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:LEE
Last Name:STEWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 STONE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-1601
Mailing Address - Country:US
Mailing Address - Phone:702-929-4209
Mailing Address - Fax:
Practice Address - Street 1:1117 STONE RIVER DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-1601
Practice Address - Country:US
Practice Address - Phone:702-929-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant