MEDICARE: SHAKIA QUINSHA STEWART LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	95407	TN

General Provider Information

NPI Number	:	1104541911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKIA QUINSHA STEWART LPN

Provider Business Mailing Address
First Line	:	101 PARMA RD
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-6407
Country	:	US
Telephone Number	:	865-282-1650
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 PARMA RD
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-6407
Country	:	US
Telephone Number	:	865-282-1650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	10/05/2022

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