Provider Demographics
NPI:1669270443
Name:STEWART, VIVIAN ELAINE
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ELAINE
Last Name:STEWART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 N 65TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1535
Mailing Address - Country:US
Mailing Address - Phone:402-553-1042
Mailing Address - Fax:
Practice Address - Street 1:5423 N 65TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1535
Practice Address - Country:US
Practice Address - Phone:402-290-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor