Provider Demographics
NPI:1982042651
Name:STEWART -GUEST, CLARISSA DAWN (ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:DAWN
Last Name:STEWART -GUEST
Suffix:
Gender:F
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 W SHIAWASSEE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1706
Mailing Address - Country:US
Mailing Address - Phone:810-750-2004
Mailing Address - Fax:
Practice Address - Street 1:2359 W SHIAWASSEE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1706
Practice Address - Country:US
Practice Address - Phone:810-750-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINCCAOM102482171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist