Provider Demographics
NPI:1386968550
Name:STEWART, MARCELINA MIGDALIA (RN)
Entity type:Individual
Prefix:
First Name:MARCELINA
Middle Name:MIGDALIA
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 1:61 TAMARACK ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1909
Mailing Address - Country:US
Mailing Address - Phone:917-515-6271
Mailing Address - Fax:
Practice Address - Street 1:61 TAMARACK ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1909
Practice Address - Country:US
Practice Address - Phone:917-515-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY585456-1163W00000X
NY284237-1164W00000X
NYF310272-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse