Provider Demographics
NPI:1821594813
Name:STEWART, DORI GENELLE
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:GENELLE
Last Name:STEWART
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 1:5500 STATE HIGHWAY 121 APT 2132
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4321
Mailing Address - Country:US
Mailing Address - Phone:817-909-8818
Mailing Address - Fax:
Practice Address - Street 1:5500 STATE HIGHWAY 121 APT 2132
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4321
Practice Address - Country:US
Practice Address - Phone:817-909-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304724164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse