Provider Demographics
NPI:1952762304
Name:STEWART, EILEEN WHITTLE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:WHITTLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:TERESA
Other - Last Name:WHITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69 VAN HORN ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3048
Mailing Address - Country:US
Mailing Address - Phone:413-209-2984
Mailing Address - Fax:
Practice Address - Street 1:69 VAN HORN ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3048
Practice Address - Country:US
Practice Address - Phone:413-209-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN15329163W00000X
MAL-47384163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAL-47384OtherIBCLC
MARN153329OtherRN