Provider Demographics
NPI:1780294967
Name:STEWARDSON, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STEWARDSON
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 1:24934 STILLMAN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:TX
Mailing Address - Zip Code:76527-4808
Mailing Address - Country:US
Mailing Address - Phone:254-681-9213
Mailing Address - Fax:
Practice Address - Street 1:2408 S 37TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7168
Practice Address - Country:US
Practice Address - Phone:254-771-6750
Practice Address - Fax:254-778-0156
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily