Provider Demographics
NPI:1265980700
Name:STEWART, LEONETTE (RDMS, BSRT)
Entity type:Individual
Prefix:
First Name:LEONETTE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:RDMS, BSRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4348 WAIALAE AVE # 502
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5767
Mailing Address - Country:US
Mailing Address - Phone:808-551-2269
Mailing Address - Fax:
Practice Address - Street 1:4348 WAIALAE AVE # 502
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5767
Practice Address - Country:US
Practice Address - Phone:808-551-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5241-5OtherHAWAII MEDICAL SERVICES ASSOCIATION
HI30383Medicare PIN