Healthcare Provider Details

I. General information

NPI: 1003507906
Provider Name (Legal Business Name): GENEVA JOY STEWART APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1100
CHICAGO IL
60611-2954
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 1100
CHICAGO IL
60611-2954
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5060
  • Fax: 312-695-5010
Mailing address:
  • Phone: 312-695-5060
  • Fax: 312-695-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041.482818
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027948
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: