Individual
MIKETTA DERELLE STEWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1555 MEADOWVIEW DRIVE, SUITED 5 & 6, DANVILLE, VA 24541
(877) 848-9810
Mailing address
422 JOHN ST, EDEN, NC 27288-2879
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
91518
NC
Other
Enumeration date
05/01/2025
Last updated
05/01/2025
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