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NPI Code Detail

MEDICARE: ROBERTA MARY STEWART MSN RN FNP

MEDICARE: ROBERTA MARY STEWART MSN RN FNP
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
1363L00000XNurse Practitioner0024057384VA

General Provider Information

NPI Number : 1396847778
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTA MARY STEWART MSN RN FNP
Provider Business Mailing Address
First Line : 3315 HIGH ST
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23707-3319
Country : US
Telephone Number : 757-399-0759
Fax Number : 757-399-3892
Provider Business Practice Location Address
First Line : 3315 HIGH ST
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23707-3319
Country : US
Telephone Number : 757-399-0759
Fax Number : 757-399-3892
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2006
Last Update Date : 08/07/2007

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