Individual
THERESA DENISE STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 N HURON ST STE 10, YPSILANTI, MI 48197-2842
(734) 480-0125
(734) 480-0125
Mailing address
8591 LAGOON DR, YPSILANTI, MI 48197-6787
(734) 829-7345
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703087489
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629279732
—
MI
Enumeration date
12/18/2017
Last updated
12/18/2017
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