Individual
MR. NATHANIEL STEWART JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., L.P.
Contact information
Practice address
1535 LAUREL AVE, SAINT PAUL, MN 55104-6739
(651) 645-0645
(651) 645-0630
Mailing address
1535 LAUREL AVE, SAINT PAUL, MN 55104-6739
(651) 645-0645
(651) 645-0630
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
LP2279
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62-73761
MEDICA
MN
01
—
86656ST
BCBS
MN
01
—
UCARE MN
111770
MN
Enumeration date
12/13/2006
Last updated
07/09/2007
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