Provider Demographics
NPI:1306936398
Name:STEWART, LAURIE LEE (CRNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LEE
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 1:104 WELLNESS WAY
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9706
Mailing Address - Country:US
Mailing Address - Phone:724-225-3640
Mailing Address - Fax:724-225-3093
Practice Address - Street 1:104 WELLNESS WAY
Practice Address - Street 2:BLDG. 2
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-225-3640
Practice Address - Fax:724-225-3093
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003688G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASI877703Medicare ID - Type Unspecified