Provider Demographics
NPI:1033282298
Name:STEWART, MARY LYNNE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 S MAXWELTON RD
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260
Mailing Address - Country:US
Mailing Address - Phone:360-321-6642
Mailing Address - Fax:
Practice Address - Street 1:107 S MAIN
Practice Address - Street 2:D203
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239
Practice Address - Country:US
Practice Address - Phone:360-678-5840
Practice Address - Fax:360-678-1400
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00056409164W00000X
WAAP30003700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
11545TOtherREGENCE
11545TOtherREGENCE