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General NPI Number Information
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NPI Number | 1942298773
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Entity Type | Individual
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Provider Name | BETTY L STEWART PAC
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Gender | Female
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 19500 10TH AVE SUITE 100
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City | POULSBO
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State | WA
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Zip | 98370-6331
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Country | US
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Telephone | 360-598-7500
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Fax | 360-598-7505
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Provider Business Mailing Address
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Address Line | 2520 CHERRY AVE
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City | BREMERTON
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State | WA
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Zip | 98310-4229
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Country | US
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Telephone | 360-598-7500
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Fax | 360-598-7505
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10003764
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License Number State | WA
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