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NPI Code Detail

MEDICARE: ABIGAIL JEAN BRINDUSA STEWART PA-C

MEDICARE: ABIGAIL JEAN BRINDUSA STEWART PA-C
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
1363A00000XPhysician Assistant7866-23WI

General Provider Information

NPI Number : 1760230452
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL JEAN BRINDUSA STEWART PA-C
Provider Business Mailing Address
First Line : 4137 LATHROP AVE
Second Line :
City : MOUNT PLEASANT
State : WI
Zip : 53405-4911
Country : US
Telephone Number : 262-664-3055
Fax Number :
Provider Business Practice Location Address
First Line : 4328 OLD GREEN BAY RD
Second Line :
City : MOUNT PLEASANT
State : WI
Zip : 53403-9489
Country : US
Telephone Number : 262-687-7606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2024
Last Update Date : 05/08/2024

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Directions to “ ABIGAIL JEAN BRINDUSA STEWART PA-C” Practice Location

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