1306254016 NPI number — MRS. ELIZABETH ANN STEWART PHYSICIAN ASSISTANT

Table of content: MRS. ELIZABETH ANN STEWART PHYSICIAN ASSISTANT (NPI 1306254016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306254016 NPI number — MRS. ELIZABETH ANN STEWART PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICIAN ASSISTANT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306254016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 N IH 35
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78664-2928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-964-6992
Provider Business Mailing Address Fax Number:
512-610-5679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 N IH 35
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78664-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-964-6992
Provider Business Practice Location Address Fax Number:
512-610-5679
Provider Enumeration Date:
07/25/2014

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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