1295822740 NPI number — MR. GREGORY DOUGLAS STEWART SR. PA, RN, CNOR, CRNFA

Table of content: MR. GREGORY DOUGLAS STEWART SR. PA, RN, CNOR, CRNFA (NPI 1295822740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295822740 NPI number — MR. GREGORY DOUGLAS STEWART SR. PA, RN, CNOR, CRNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
GREGORY
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PA, RN, CNOR, CRNFA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295822740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1542
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUKILTEO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98275-7742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-948-4671
Provider Business Mailing Address Fax Number:
425-513-9456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 122ND ST SW
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98204-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-948-4671
Provider Business Practice Location Address Fax Number:
425-513-9456
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA10002153 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WR0006X , with the licence number: 25800059197 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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