Provider Demographics
NPI:1043442254
Name:STEWART, GWENDOLYN J (DNP, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:J
Last Name:STEWART
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:411 N WASHINGTON AVE STE 6000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1789
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6988
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118552363LF0000X, 363L00000X, 363L00000X
MSR881390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP118552OtherNURSE PRACTITIONER
TXAP118552OtherNURSE PRACTITIONER