MEDICARE: DANIELLE M STEWART PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1245466903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE M STEWART PA

Provider Business Mailing Address
First Line	:	1575 OUTRIDER WAY
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-8049
Country	:	US
Telephone Number	:	719-330-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1495 GARDEN OF THE GODS RD STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3429
Country	:	US
Telephone Number	:	719-260-9797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	12/20/2019

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