MEDICARE: ANGELA STEWART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	DBJ1699	NC

General Provider Information

NPI Number	:	1023564564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA STEWART

Provider Business Mailing Address
First Line	:	4306 PRINCETON AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1728
Country	:	US
Telephone Number	:	336-854-4534
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 PRINCETON AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1728
Country	:	US
Telephone Number	:	336-854-4534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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Directions to “ ANGELA STEWART ” Practice Location

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