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General NPI Number Information
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NPI Number | 1538953286
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Entity Type | Individual
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Provider Name | ANTONIA ISABEL STEWART HIS
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Gender | Female
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 325 NE BAKER CREEK RD
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City | MCMINNVILLE
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State | OR
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Zip | 97128-2019
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Country | US
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Telephone | 503-472-5554
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Fax | 503-474-0998
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Provider Business Mailing Address
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Address Line | 541 SE FORD ST APT 4
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City | MCMINNVILLE
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State | OR
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Zip | 97128-6133
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Country | US
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Telephone | 719-644-5384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 10254462
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License Number State | OR
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