Provider Demographics
NPI:1982825113
Name:STEWART, KAREN BERNADETTE (LVN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:BERNADETTE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56079
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-0079
Mailing Address - Country:US
Mailing Address - Phone:310-739-5295
Mailing Address - Fax:
Practice Address - Street 1:11315 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3007
Practice Address - Country:US
Practice Address - Phone:310-537-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN132856164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse