Provider Demographics
NPI:1801298633
Name:STEWART, LENA
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:STEWART
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KALSKAG
Mailing Address - State:AK
Mailing Address - Zip Code:99607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LOT 3 BLOCK 11 TRACT C
Practice Address - Street 2:
Practice Address - City:KALSKAG
Practice Address - State:AK
Practice Address - Zip Code:99607
Practice Address - Country:US
Practice Address - Phone:907-471-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker