Provider Demographics
NPI:1265039440
Name:STEWART, ANN LYNNETTE
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:LYNNETTE
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 1:3487 MOGADORE RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-7435
Mailing Address - Country:US
Mailing Address - Phone:330-475-5343
Mailing Address - Fax:
Practice Address - Street 1:3487 MOGADORE RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-7435
Practice Address - Country:US
Practice Address - Phone:330-475-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6705131253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care