=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750913489
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIERRA L STUART FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2020
-----------------------------------------------------
Last Update Date | 09/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2312 NE 129TH ST
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98686-3236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-546-8937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27003 NE 119TH AVE
-----------------------------------------------------
City | BATTLE GROUND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98604-6539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-597-6944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 201907158NP-PP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP61028185
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------