Healthcare Provider Details

I. General information

NPI: 1033282298
Provider Name (Legal Business Name): MARY LYNNE STEWART ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S MAIN D203
COUPEVILLE WA
98239
US

IV. Provider business mailing address

5936 S MAXWELTON RD
LANGLEY WA
98260
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-5840
  • Fax: 360-678-1400
Mailing address:
  • Phone: 360-321-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberRN00056409
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30003700
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: