Provider Demographics
NPI:1215290168
Name:STEWART, MARY PAULINE (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PAULINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 HIGHWAY 183
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-7160
Mailing Address - Country:US
Mailing Address - Phone:318-728-4441
Mailing Address - Fax:318-728-6291
Practice Address - Street 1:21 LYNN GAYLE ROBERTSON RD
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-4068
Practice Address - Country:US
Practice Address - Phone:318-728-4441
Practice Address - Fax:318-728-6291
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN032800163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health