Healthcare Provider Details

I. General information

NPI: 1033201512
Provider Name (Legal Business Name): VERNETTA M. STEWART ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLBY AVE
EVERETT WA
98201-1665
US

IV. Provider business mailing address

1321 COLBY AVE MEDICAL STAFF OFFICE
EVERETT WA
98201-1665
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-7390
  • Fax: 425-258-7379
Mailing address:
  • Phone: 425-525-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30005819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: