Provider Demographics
NPI:1750643565
Name:STEWART, ALLEN M (NP)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:M
Last Name:STEWART
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LANSDOWNE LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-1932
Mailing Address - Country:US
Mailing Address - Phone:317-417-2593
Mailing Address - Fax:
Practice Address - Street 1:9535 E 151ST ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-0050
Practice Address - Country:US
Practice Address - Phone:317-523-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003998A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201073490Medicaid
INP01456885OtherRR MEDICARE
INM400074157Medicare PIN