Provider Demographics
NPI:1881903847
Name:STEWART, PENNY C (LPN)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:C
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 1:16365 HEATHER LANE
Mailing Address - Street 2:#201
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-234-5331
Mailing Address - Fax:
Practice Address - Street 1:16365 HEATHER LN
Practice Address - Street 2:3201
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-8321
Practice Address - Country:US
Practice Address - Phone:440-234-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.N.094186164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse