Healthcare Provider Details

I. General information

NPI: 1912559360
Provider Name (Legal Business Name): MARCEE STEWART FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21610 PACIFIC WAY
OCEAN PARK WA
98640-3206
US

IV. Provider business mailing address

1770 PACKSADDLE RD
WALDRON AR
72958-7231
US

V. Phone/Fax

Practice location:
  • Phone: 360-665-3000
  • Fax: 360-665-3096
Mailing address:
  • Phone: 479-310-6402
  • Fax: 479-473-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number63629
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201905669NP-PP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70087077
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227761
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: