Provider Demographics
NPI:1750944138
Name:STEWART, YOLANDA (RN,BSN)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 BENDING OAK DR APT 423
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-7012
Mailing Address - Country:US
Mailing Address - Phone:817-386-3476
Mailing Address - Fax:
Practice Address - Street 1:1117 BENDING OAK DR APT 423
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-7012
Practice Address - Country:US
Practice Address - Phone:817-386-3476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1619154163WG0600X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA