Healthcare Provider Details

I. General information

NPI: 1093257172
Provider Name (Legal Business Name): STEWART LEWIS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 N LA CHOLLA BLVD
TUCSON AZ
85741
US

IV. Provider business mailing address

7105 N LA CHOLLA BLVD
TUCSON AZ
85741
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-0611
  • Fax: 520-547-0616
Mailing address:
  • Phone: 520-547-0611
  • Fax: 520-547-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP9566
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: