Provider Demographics
NPI:1164747275
Name:STEWART, ALLISON (CPNP-AC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-5454
Mailing Address - Fax:515-643-5460
Practice Address - Street 1:330 LAUREL ST.
Practice Address - Street 2:SUITE 1200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3068
Practice Address - Country:US
Practice Address - Phone:515-643-5454
Practice Address - Fax:515-643-5460
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099177363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1164747275Medicaid
IA175150093OtherMEDICARE