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General NPI Number Information
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NPI Number | 1316256381
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Entity Type | Individual
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Provider Name | TRACI L STEWART DNP, NP
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Gender | Female
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 4646 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-576-3663
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Fax |
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Provider Business Mailing Address
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Address Line | 702 N HARVEY ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1268
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Country | US
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Telephone | 248-202-7070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704248292
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704248292
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License Number State | MI
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