Provider Demographics
NPI:1184399867
Name:STEWART, AUDREY (CPM)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 BIENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5605
Mailing Address - Country:US
Mailing Address - Phone:504-715-8889
Mailing Address - Fax:
Practice Address - Street 1:6100 CANAL BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3001
Practice Address - Country:US
Practice Address - Phone:504-715-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA328405176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife