Provider Demographics
NPI:1730487331
Name:STEWART, PATRICIA ANNE (FNP, RN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:REARDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1415 PORTLAND AVE
Mailing Address - Street 2:MEDICAL OFFICE BUILDING, SUITE 350
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3038
Mailing Address - Country:US
Mailing Address - Phone:585-922-9308
Mailing Address - Fax:585-922-9335
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:MEDICAL OFFICE BUILDING, SUITE 350
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-922-9308
Practice Address - Fax:585-922-9335
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205224163W00000X
NY333115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse