Provider Demographics
NPI:1972989648
Name:STEWART, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9094 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:HANOVERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44423-9626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9094 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:HANOVERTON
Practice Address - State:OH
Practice Address - Zip Code:44423-9626
Practice Address - Country:US
Practice Address - Phone:330-429-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104351-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse