Provider Demographics
NPI:1003891086
Name:TAYLOR-STEWART, RITA JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:JEAN
Last Name:TAYLOR-STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:JEAN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:502 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-2254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN HORNE
Practice Address - State:IA
Practice Address - Zip Code:52346-9713
Practice Address - Country:US
Practice Address - Phone:319-228-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R81048Medicare UPIN
IA58568Medicare ID - Type Unspecified