Provider Demographics
NPI:1902018815
Name:STEWART, MISTY MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:475 AMANDA NORTHERN RD
Mailing Address - Street 2:
Mailing Address - City:AMANDA
Mailing Address - State:OH
Mailing Address - Zip Code:43102
Mailing Address - Country:US
Mailing Address - Phone:740-969-2423
Mailing Address - Fax:740-969-2423
Practice Address - Street 1:5668 SUMMERWOOD CROSSING
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021
Practice Address - Country:US
Practice Address - Phone:614-275-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN106914164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse