Provider Demographics
NPI:1447464672
Name:STEWART, CINDY RAE (LPN, LMP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:RAE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPN, LMP
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 31
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-0031
Mailing Address - Country:US
Mailing Address - Phone:509-322-2592
Mailing Address - Fax:
Practice Address - Street 1:318 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-9281
Practice Address - Country:US
Practice Address - Phone:509-486-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00039749164W00000X
WAMA00008040225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60270650811OtherUBI