Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1164938882 |
---|---|
Provider Name | Karie Stewart |
First Address | Mount Vernon, IL 62864-2822 |
Second Address | Mount Vernon, IL 62864-2822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2017 |
Last Update Date | 18/12/2017 |