Provider Demographics
NPI:1205133154
Name:STEWART, TIAJUANA (RN)
Entity type:Individual
Prefix:
First Name:TIAJUANA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 LAWFORD LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5542
Mailing Address - Country:US
Mailing Address - Phone:804-248-3928
Mailing Address - Fax:
Practice Address - Street 1:551 LAWFORD LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-5542
Practice Address - Country:US
Practice Address - Phone:804-248-3928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001163979163WP0808X, 101YA0400X, 163WA0400X, 163WC0400X, 163WC1400X, 163WC1500X, 163WH0200X, 163WP0000X, 163WP0200X, 163WP0807X, 163WP0809X, 163WS0200X, 372500000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No372500000XNursing Service Related ProvidersChore Provider
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist