Basic Information
| Provider Information | |||||||||
| NPI: | 1609809243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWARD | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | SHANNON | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 173 MIDDLE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035843508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037885029 | ||||||||
| FaxNumber: | 6037885607 | ||||||||
| Practice Location | |||||||||
| Address1: | 47 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GROVETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035824061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036361101 | ||||||||
| FaxNumber: | 6037885059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60072704 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | CNP181089 | ME | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 078577-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P01745240 | 01 | WA | RR MEDICARE WVH | OTHER | 1609809243 | 05 | WA | MEDICAID |