Healthcare Provider Details

I. General information

NPI: 1063796191
Provider Name (Legal Business Name): BARBARA STEWART ANP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 ECHO WAY
EAGLE POINT OR
97524-9626
US

IV. Provider business mailing address

1208 BEALL LN
CENTRAL POINT OR
97502-1573
US

V. Phone/Fax

Practice location:
  • Phone: 541-261-8444
  • Fax:
Mailing address:
  • Phone: 541-664-5151
  • Fax: 877-772-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number076037070N3 ANP PP
License Number StatePR

VIII. Authorized Official

Name: BARBARA STEWART
Title or Position: PRESIDENT
Credential: ANP
Phone: 541-261-8444