Healthcare Provider Details

I. General information

NPI: 1609464874
Provider Name (Legal Business Name): NANETTE STEWART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 HIGHWAY 589
PURVIS MS
39475-4194
US

IV. Provider business mailing address

4100 MAMIE ST
HATTIESBURG MS
39402-1735
US

V. Phone/Fax

Practice location:
  • Phone: 601-794-6543
  • Fax:
Mailing address:
  • Phone: 601-705-1901
  • Fax: 601-705-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR906495
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: