Healthcare Provider Details

I. General information

NPI: 1306936398
Provider Name (Legal Business Name): LAURIE LEE STEWART CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WELLNESS WAY BLDG. 2
WASHINGTON PA
15301
US

IV. Provider business mailing address

104 WELLNESS WAY BLDG. 2
WASHINGTON PA
15301-9706
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-3640
  • Fax: 724-225-3093
Mailing address:
  • Phone: 724-225-3640
  • Fax: 724-225-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberUP003688G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: