Provider Demographics
NPI:1235880279
Name:STEWMAN, JODI
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:STEWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2604
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-2604
Mailing Address - Country:US
Mailing Address - Phone:833-632-1248
Mailing Address - Fax:833-632-1248
Practice Address - Street 1:2194 N SERENITA ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-3189
Practice Address - Country:US
Practice Address - Phone:435-632-2099
Practice Address - Fax:833-632-1248
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT00008376343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0207468Medicaid