Provider Demographics
NPI:1437976636
Name:STEWART, RANDALL LEE (LPN)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:STEWART
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 WESTSHORE DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-6319
Mailing Address - Country:US
Mailing Address - Phone:989-671-7787
Mailing Address - Fax:
Practice Address - Street 1:890 N 10TH ST STE 110
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-6192
Practice Address - Country:US
Practice Address - Phone:888-527-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703130414164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse