Healthcare Provider Details

I. General information

NPI: 1518712694
Provider Name (Legal Business Name): ELIZABETH BRUTKIEWICZ STEWART CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 DAUPHIN ST STE 1100
MOBILE AL
36608-1785
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE D330
MOBILE AL
36608-6758
US

V. Phone/Fax

Practice location:
  • Phone: 251-607-9797
  • Fax:
Mailing address:
  • Phone: 251-607-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1164347
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: