Healthcare Provider Details

I. General information

NPI: 1245090430
Provider Name (Legal Business Name): ESSENCE STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 E BASELINE RD STE 101
GILBERT AZ
85234-2750
US

IV. Provider business mailing address

691 E BANELLI PL
CHANDLER AZ
85286-1317
US

V. Phone/Fax

Practice location:
  • Phone: 490-787-5387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberOTA-050026
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: