Provider Demographics
NPI:1992742514
Name:STEWART, DIANE (RN/C, APN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN/C, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:1303 W. EVERGREEN AVE.
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1387
Mailing Address - Country:US
Mailing Address - Phone:217-342-3400
Mailing Address - Fax:217-342-6416
Practice Address - Street 1:1303 W EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1619
Practice Address - Country:US
Practice Address - Phone:217-342-3400
Practice Address - Fax:217-342-6416
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041156989163W00000X
IL209000727363L00000X, 363LA2200X, 364SA2200X, 364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN267692OtherHEALTHLINK
IN267692OtherHEALTHLINK
IL960770Medicare ID - Type Unspecified