Provider Information for 1952085987
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CARLA JO STEWART
Sex: Female
NPI: 1952085987
Last Updated: 2025-01-16
Certification Date: 2025-01-16
Certification Date: 2025-01-16
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1952085987 | ||||||||
| Enumeration Date | 2023-06-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 401 CEDAR DR CLINTON, IL 61727-2411 United States Phone: 217-521-6763 | Fax: | ||||||||
| Primary Practice Address | 401 CEDAR DR CLINTON, IL 61727-2411 United States Phone: 217-521-6763 | Fax: | ||||||||
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