Healthcare Provider Details
I. General information
NPI: 1205133154
Provider Name (Legal Business Name): TIAJUANA STEWART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/11/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
551 LAWFORD LN
MIDLOTHIAN VA
23114-5542
US
IV. Provider business mailing address
551 LAWFORD LN
MIDLOTHIAN VA
23114-5542
US
V. Phone/Fax
- Phone: 804-248-3928
- Fax:
- Phone: 804-248-3928
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WP0808X |
| Taxonomy | Psychiatric/Mental Health Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 0001163979 |
| License Number State | VA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1400X |
| Taxonomy | College Health Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0000X |
| Taxonomy | Pain Management Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0200X |
| Taxonomy | Pediatric Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0807X |
| Taxonomy | Child & Adolescent Psychiatric/Mental Health Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0809X |
| Taxonomy | Adult Psychiatric/Mental Health Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WS0200X |
| Taxonomy | School Registered Nurse |
| License Number | 0001163979 |
| License Number State | VA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 372500000X |
| Taxonomy | Chore Provider |
| License Number | 0001163979 |
| License Number State | VA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 373H00000X |
| Taxonomy | Day Training/Habilitation Specialist |
| License Number | 0001163979 |
| License Number State | VA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
