MEDICARE: MS. JACQUELINE JEWELL STEWARAT LVN

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	164X00000X	Licensed Vocational Nurse	61006	TX

General Provider Information

NPI Number	:	1609088749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE JEWELL STEWARAT LVN

Provider Business Mailing Address
First Line	:	5646 MISTY GLN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1375
Country	:	US
Telephone Number	:	210-286-7531
Fax Number	:	210-650-5980

Provider Business Practice Location Address
First Line	:	5646 MISTY GLN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1375
Country	:	US
Telephone Number	:	210-286-7531
Fax Number	:	210-650-5980

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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