Healthcare Provider Details

I. General information

NPI: 1194535369
Provider Name (Legal Business Name): LAUREN ROSE STEWART FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HILLSIDE AVE
PROVIDENCE RI
02906-2943
US

IV. Provider business mailing address

99 HILLSIDE AVE
PROVIDENCE RI
02906-2943
US

V. Phone/Fax

Practice location:
  • Phone: 781-480-7017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN04502
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR225592
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: