Provider Demographics
NPI:1942083951
Name:STEWART, HEATHER RENE (LPN II)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPN II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 HIGHLAND PLANTATION RD TRLR 60
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-9216
Mailing Address - Country:US
Mailing Address - Phone:662-822-9102
Mailing Address - Fax:
Practice Address - Street 1:1467 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7141
Practice Address - Country:US
Practice Address - Phone:662-335-1621
Practice Address - Fax:662-335-8128
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP325795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse