Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A154720 | CA |
NPI | 1003251778 |
---|---|
Provider Name | Carrie Aline Stewart |
First Address | Hazel Green, AL 35750-9719 |
Second Address | New Orleans, LA 70112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 30/07/2019 |