Healthcare Provider Details

I. General information

NPI: 1750643565
Provider Name (Legal Business Name): ALLEN M STEWART NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 E 151ST ST
NOBLESVILLE IN
46060-0050
US

IV. Provider business mailing address

9 LANSDOWNE LN
CARMEL IN
46033-1932
US

V. Phone/Fax

Practice location:
  • Phone: 317-523-9160
  • Fax:
Mailing address:
  • Phone: 317-417-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003998A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: