Provider Demographics
NPI:1720694631
Name:STEWART, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:43107-1031
Mailing Address - Country:US
Mailing Address - Phone:740-270-9908
Mailing Address - Fax:
Practice Address - Street 1:241 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:OH
Practice Address - Zip Code:43107-1031
Practice Address - Country:US
Practice Address - Phone:740-270-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty