Provider Demographics
NPI:1831629245
Name:STEWART, CARISSA BONANY (LPN)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:BONANY
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33001 VINE ST APT E9
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3359
Mailing Address - Country:US
Mailing Address - Phone:440-223-3432
Mailing Address - Fax:
Practice Address - Street 1:4745 MARIGOLD RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1135
Practice Address - Country:US
Practice Address - Phone:440-227-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.152364.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse