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NPI Code Detail

MEDICARE: MISS SUSAN ANN STEWART RN, FNP-BC

MEDICARE: MISS SUSAN ANN STEWART RN, FNP-BC
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
1363LF0000XFamily Nurse Practitioner26NN04826800NJ

General Provider Information

NPI Number : 1235374240
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SUSAN ANN STEWART RN, FNP-BC
Provider Business Mailing Address
First Line : 512 LAKELAND RD
Second Line : DIPIERO CENTER, SUITE 536
City : BLACKWOOD
State : NJ
Zip : 08012-2946
Country : US
Telephone Number : 856-374-6248
Fax Number : 856-374-6210
Provider Business Practice Location Address
First Line : 2631 FEDERAL ST
Second Line : EAST CAMDEN HEALTH CENTER
City : CAMDEN
State : NJ
Zip : 08105-1935
Country : US
Telephone Number : 856-756-2266
Fax Number : 856-968-2307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2008
Last Update Date : 12/04/2008

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