Provider Demographics
NPI:1700538360
Name:STEWART, JANAYE PATRICE (RN)
Entity Type:Individual
Prefix:
First Name:JANAYE
Middle Name:PATRICE
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4456
Mailing Address - Country:US
Mailing Address - Phone:651-955-4659
Mailing Address - Fax:
Practice Address - Street 1:1823 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4456
Practice Address - Country:US
Practice Address - Phone:651-955-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2303967163W00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty