Healthcare Provider Details

I. General information

NPI: 1538953286
Provider Name (Legal Business Name): ANTONIA ISABEL STEWART HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANTONIA ISABEL STEWART

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 NE BAKER CREEK RD
MCMINNVILLE OR
97128-2019
US

IV. Provider business mailing address

541 SE FORD ST APT 4
MCMINNVILLE OR
97128-6133
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-5554
  • Fax: 503-474-0998
Mailing address:
  • Phone: 719-644-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number10254462
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: