Provider Demographics
NPI:1700304276
Name:STEWART, TEELA (NURSE)
Entity Type:Individual
Prefix:
First Name:TEELA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16627 DESERT STAR ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1425
Mailing Address - Country:US
Mailing Address - Phone:951-205-8224
Mailing Address - Fax:
Practice Address - Street 1:16627 DESERT STAR ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1425
Practice Address - Country:US
Practice Address - Phone:951-205-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280612164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse