Provider Demographics
NPI:1972043685
Name:STEWART, ANN CHRISTINE (ANP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:CHRISTINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:CHRISTINE
Other - Last Name:DONATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:89 GOSHEN TPKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-3145
Mailing Address - Country:US
Mailing Address - Phone:570-579-5501
Mailing Address - Fax:
Practice Address - Street 1:2 MILE DRIVE
Practice Address - Street 2:
Practice Address - City:OTISVILLE
Practice Address - State:NY
Practice Address - Zip Code:10963
Practice Address - Country:US
Practice Address - Phone:845-386-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308193363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04980769Medicaid