Provider Demographics
NPI:1396382040
Name:STEWART, CARNETTA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CARNETTA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 AMBROSE TER
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2301
Mailing Address - Country:US
Mailing Address - Phone:860-830-2350
Mailing Address - Fax:
Practice Address - Street 1:2550 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1936
Practice Address - Country:US
Practice Address - Phone:860-400-2550
Practice Address - Fax:860-506-7818
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily