Provider Demographics
NPI:1003467168
Name:STUART, ELIZABETH VIVIAN
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:VIVIAN
Last Name:STUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 307
Mailing Address - Street 2:4968 SHIGLEY LANE
Mailing Address - City:CONNER
Mailing Address - State:MT
Mailing Address - Zip Code:59827
Mailing Address - Country:US
Mailing Address - Phone:406-360-8990
Mailing Address - Fax:
Practice Address - Street 1:4968 SHIGLEY LANE
Practice Address - Street 2:
Practice Address - City:CONNER
Practice Address - State:MT
Practice Address - Zip Code:59827
Practice Address - Country:US
Practice Address - Phone:406-360-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker