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NPI Code Detail

MEDICARE: ANDRE B STEWART, LLC

MEDICARE: ANDRE B STEWART, LLC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerRN095097LA

General Provider Information

NPI Number : 1710325956
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANDRE B STEWART, LLC
Provider Business Mailing Address
First Line : PO BOX 82677
Second Line :
City : BATON ROUGE
State : LA
Zip : 70884-2677
Country : US
Telephone Number : 225-243-4554
Fax Number : 225-243-4554
Provider Business Practice Location Address
First Line : 10425 PLAZA AMERICANA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-8188
Country : US
Telephone Number : 225-810-4719
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : ANDRE B STEWART
Credential : NP
Telephone Number : 225-806-1956
Provider Enumeration Date : 06/10/2013
Last Update Date : 06/10/2013

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