Provider Demographics
NPI:1932216462
Name:STEWART, MARSENA MAYFIELD (CRNP)
Entity Type:Individual
Prefix:
First Name:MARSENA
Middle Name:MAYFIELD
Last Name:STEWART
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MAIN AVE SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055
Mailing Address - Country:US
Mailing Address - Phone:256-734-3759
Mailing Address - Fax:256-734-9764
Practice Address - Street 1:1900 MAIN AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055
Practice Address - Country:US
Practice Address - Phone:256-734-3759
Practice Address - Fax:256-734-9764
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-073260363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-073260OtherALABAMA LICENSE NUMBER