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NPI Code Detail

MEDICARE: MITZY D. STEWART APRN

MEDICARE: MITZY D. STEWART APRN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1635594405UT
2363LP0808XPsychiatric/Mental Health Nurse Practitioner163559-4405UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2163559-4405OTHERUTSTATE LICENSE NUMBER

General Provider Information

NPI Number : 1538147418
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITZY D. STEWART APRN
Provider Business Mailing Address
First Line : 5689 S REDWOOD RD
Second Line :
City : TAYLORSVILLE
State : UT
Zip : 84123-5447
Country : US
Telephone Number : 12-681-7158
Fax Number :
Provider Business Practice Location Address
First Line : 934 S MAIN ST
Second Line :
City : LAYTON
State : UT
Zip : 84041-7135
Country : US
Telephone Number : 801-773-7060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 09/27/2018

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