Provider Demographics
NPI:1023428638
Name:STEWART, JODY
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S. MAIN STREET
Mailing Address - Street 2:EDISON LOCAL SCHOOL DISTRICT
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 S. MAIN STREET
Practice Address - Street 2:EDISON LOCAL SCHOOL DISTRICT
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846
Practice Address - Country:US
Practice Address - Phone:419-499-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRN215003163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool