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General NPI Number Information
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NPI Number | 1962040501
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Entity Type | Individual
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Provider Name | DOMINIQUE ROCHELLE STEWART CNP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2300 E MAIN ST
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City | RICHMOND
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State | IN
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Zip | 47374
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Country | US
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Telephone | 765-598-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 REID PARKWAY MEDICAL STAFF SERVICES
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City | RICHMOND
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State | IN
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Zip | 47374
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Country | US
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Telephone | 765-983-3127
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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 | APRN.CNP.025226
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.025226
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71015644A
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License Number State | IN
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