Provider Demographics
NPI:1033962998
Name:STEWART, JEFFERY WEGLIN
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:WEGLIN
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 LINCOLNWAY W STE J
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-2061
Mailing Address - Country:US
Mailing Address - Phone:574-204-2755
Mailing Address - Fax:574-213-0825
Practice Address - Street 1:1415 LINCOLNWAY W STE J
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2061
Practice Address - Country:US
Practice Address - Phone:574-204-2755
Practice Address - Fax:574-213-0825
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN230153631163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health