Healthcare Provider Details

I. General information

NPI: 1760707962
Provider Name (Legal Business Name): CONNIE LOUISE STEWART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LAWRENCE ST
DENVER CO
80205-2126
US

IV. Provider business mailing address

20722 TOLLERBERG RD
TRINIDAD CO
81082-8602
US

V. Phone/Fax

Practice location:
  • Phone: 303-996-6061
  • Fax:
Mailing address:
  • Phone: 303-898-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number178845
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: