Healthcare Provider Details

I. General information

NPI: 1861558249
Provider Name (Legal Business Name): JOYCE C. STEWART-BORDERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYCE C. BORDERS

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 8TH ST SUITE 238
EAST SAINT LOUIS IL
62201-2989
US

IV. Provider business mailing address

100 N 8TH ST SUITE 238
EAST SAINT LOUIS IL
62201-2989
US

V. Phone/Fax

Practice location:
  • Phone: 618-274-9105
  • Fax: 618-274-9101
Mailing address:
  • Phone: 618-274-9105
  • Fax: 618-274-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number140095
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209004956
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041227301
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number140095
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: