Provider Demographics
NPI:1881827129
Name:STEWART, JACQUELINE ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANNE
Other - Last Name:MCCLINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2611 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2960
Mailing Address - Country:US
Mailing Address - Phone:402-423-4200
Mailing Address - Fax:402-423-4201
Practice Address - Street 1:6030 VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4773
Practice Address - Country:US
Practice Address - Phone:402-413-0417
Practice Address - Fax:883-992-2061
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111074363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47097OtherBCBS NE
NE47117OtherBCBS NE - PRIMUS
NE47097OtherBCBS NE
NE47117OtherBCBS NE - PRIMUS
NE099827007Medicare PIN
NENA1466008Medicare PIN