Provider Demographics
NPI:1831587070
Name:STEWART, PENELOPE (CNA)
Entity type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 S SPRING ST
Mailing Address - Street 2:A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4530
Mailing Address - Country:US
Mailing Address - Phone:501-398-4878
Mailing Address - Fax:
Practice Address - Street 1:413 S SPRING ST
Practice Address - Street 2:A
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4530
Practice Address - Country:US
Practice Address - Phone:501-398-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide