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Individual

FREDA WYNELL STEWART

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
4370 W MAIN STREET, DOTHAN, AL 36305
(334) 793-5000
(334) 615-8419
Mailing address
PO BOX 6907, DOTHAN, AL 36302
(334) 793-5000
(334) 615-8419

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1071547
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05028303
MS
05
1771317
LA
01
51526326
BLUE CROSS BLUE SHIELD
AL
Enumeration date
03/31/2006
Last updated
07/08/2007
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