Healthcare Provider Details

I. General information

NPI: 1235880279
Provider Name (Legal Business Name): JODI STEWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2194 N SERENITA ST
WASHINGTON UT
84780-3189
US

IV. Provider business mailing address

PO BOX 2604
MESQUITE NV
89024-2604
US

V. Phone/Fax

Practice location:
  • Phone: 435-632-2099
  • Fax: 833-632-1248
Mailing address:
  • Phone: 833-632-1248
  • Fax: 833-632-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number00008376
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number00008376
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: