MEDICARE: MRS. KIMYATTA MARIE STEWART PERSNAL CARE AIDE

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	376K00000X	Nurse's Aide		OH

General Provider Information

NPI Number	:	1629287669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMYATTA MARIE STEWART PERSNAL CARE AIDE

Provider Business Mailing Address
First Line	:	1522 EDDINGTON RD
Second Line	:	FLOOR 2
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44118-1129
Country	:	US
Telephone Number	:	216-396-8052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 EDDINGTON RD
Second Line	:	FLOOR 2
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44118-1129
Country	:	US
Telephone Number	:	216-396-8052
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	05/16/2014

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