Healthcare Provider Details

I. General information

NPI: 1609809243
Provider Name (Legal Business Name): LAURIE SHANNON STEWARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 KATHERINE DR STE A
FLOWOOD MS
39232-9588
US

IV. Provider business mailing address

173 MIDDLE ST
LANCASTER NH
03584-3508
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax:
Mailing address:
  • Phone: 603-788-5029
  • Fax: 603-788-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60072704
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number078577-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP181089
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number906283
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: