Healthcare Provider Details

I. General information

NPI: 1427414929
Provider Name (Legal Business Name): TWANNA CHANNEL STEWART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 POE AVE APT A1
NEWARK NJ
07106-1552
US

IV. Provider business mailing address

51 POE AVE APT A1
NEWARK NJ
07106-1552
US

V. Phone/Fax

Practice location:
  • Phone: 202-819-8733
  • Fax:
Mailing address:
  • Phone: 202-819-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number765625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: