Provider Demographics
NPI:1770053936
Name:STUART, MARY ELIZABETH
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:STUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22023 REYNOLDS POND RD
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:DE
Mailing Address - Zip Code:19941-2641
Mailing Address - Country:US
Mailing Address - Phone:215-665-0117
Mailing Address - Fax:
Practice Address - Street 1:3100 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5391
Practice Address - Country:US
Practice Address - Phone:302-674-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0046204163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool