Healthcare Provider Details

I. General information

NPI: 1508190372
Provider Name (Legal Business Name): MONICA STEWART RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 ROCKGLEN WAY NUMBER 615
RALEIGH NC
27615-5600
US

IV. Provider business mailing address

6620 ROCKGLEN WAY NUMBER 615
RALEIGH NC
27615
US

V. Phone/Fax

Practice location:
  • Phone: 919-539-7973
  • Fax: 919-954-7098
Mailing address:
  • Phone: 919-539-7973
  • Fax: 919-954-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number226487
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number226487
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number226487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: