MEDICARE: YOLANDA STEWART RN,BSN

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	163WG0600X	Gerontology Registered Nurse	1619154	CO
2	163WM0705X	Medical-Surgical Registered Nurse	1619154	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1750944138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA STEWART RN,BSN

Provider Business Mailing Address
First Line	:	1117 BENDING OAK DR APT 423
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-7012
Country	:	US
Telephone Number	:	817-386-3476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 BENDING OAK DR APT 423
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-7012
Country	:	US
Telephone Number	:	817-386-3476
Fax Number	:

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

Provider Enumeration Date	:	04/21/2019
Last Update Date	:	06/11/2019

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