Provider Demographics
NPI:1669949400
Name:STEWARD, DALISA VIOLA
Entity type:Individual
Prefix:
First Name:DALISA
Middle Name:VIOLA
Last Name:STEWARD
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 1:3108 ORANGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5180
Mailing Address - Country:US
Mailing Address - Phone:702-689-4328
Mailing Address - Fax:
Practice Address - Street 1:1951 STELLA LAKE ST STE 36
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2144
Practice Address - Country:US
Practice Address - Phone:702-595-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2102801195Medicaid