Provider Demographics
NPI:1720346216
Name:STEWART, JONATHAN DEAN (RN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DEAN
Last Name:STEWART
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 EAST ST
Mailing Address - Street 2:ATTN: QUALITY MANAGEMENT
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1906
Mailing Address - Country:US
Mailing Address - Phone:925-674-2027
Mailing Address - Fax:
Practice Address - Street 1:2540 EAST ST
Practice Address - Street 2:ATTN: QUALITY MANAGEMENT
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1906
Practice Address - Country:US
Practice Address - Phone:925-674-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609694163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator