Individual
SUSAN ELIZABETH STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.N.P.
Contact information
Practice address
3 ST. ELIZABETH'S BLVD., STE. 2800, O'FALLON, IL 62269-1099
(618) 233-6044
(618) 233-5195
Mailing address
3 SAINT ELIZABETH BLVD STE 2800, O FALLON, IL 62269-1099
(618) 233-6044
(618) 233-5195
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
209.007628
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209007628
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01046089
RAILROAD
IL
Enumeration date
10/18/2010
Last updated
12/20/2021
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