Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01060986A | IN |
N | 2080A0000X | Adolescent Medicine | 01060986A | IN |
NPI | 1285615336 |
---|---|
Provider Name | Dana Y Stewart |
First Address | Lafayette, IN 47903-4699 |
Second Address | Lafayette, IN 47905-8651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 04/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000543815 | ANTHEM (01) | IN |
200528200 | (05) | IN |
7446741 | AETNA (01) | IN |
I38360 | (02) | IN |
P01270959 | RR MEDICARE (01) | IN |