Provider Demographics
NPI:1164700662
Name:STEWART, PATRICIA LOUISE (ACNP, FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:ACNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S PEORIA ST
Mailing Address - Street 2:#100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5476
Mailing Address - Country:US
Mailing Address - Phone:303-306-4321
Mailing Address - Fax:720-524-1551
Practice Address - Street 1:2400 S PEORIA ST
Practice Address - Street 2:#100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5476
Practice Address - Country:US
Practice Address - Phone:303-306-4321
Practice Address - Fax:720-524-1551
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP 990134363LA2100X
CONP990134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64756777Medicaid
COCOAAA3974Medicare PIN