Healthcare Provider Details

I. General information

NPI: 1457420655
Provider Name (Legal Business Name): KATHERINE SUE STUART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 PACIFIC AVE SUITE 200
SANTA CRUZ CA
95060-7503
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-5550
  • Fax: 831-425-0106
Mailing address:
  • Phone: 408-287-7532
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN398242
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN398242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: