Provider Demographics
NPI:1689714222
Name:STEWART-BANBURY, AMY (CPN-TN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STEWART-BANBURY
Suffix:
Gender:F
Credentials:CPN-TN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 AUTUMN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-2739
Mailing Address - Country:US
Mailing Address - Phone:901-292-5354
Mailing Address - Fax:901-452-8088
Practice Address - Street 1:2610 AUTUMN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-2739
Practice Address - Country:US
Practice Address - Phone:901-292-5354
Practice Address - Fax:901-452-8088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPM0000000030.176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife