Provider Demographics
NPI:1427010842
Name:STEWART, JANELLE R (PA-C)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:R
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:R
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C, PT
Mailing Address - Street 1:523 S CAMINO DEL RIO, STE B
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303
Mailing Address - Country:US
Mailing Address - Phone:970-247-1970
Mailing Address - Fax:970-259-1668
Practice Address - Street 1:523 S CAMINO DEL RIO, STE B
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303
Practice Address - Country:US
Practice Address - Phone:970-247-1970
Practice Address - Fax:970-247-1970
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8695225100000X
UT8433186-1206363A00000X
CO3765363A00000X
COPA.0003765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000128352Medicaid
CO18757049Medicaid
CO18757049Medicaid
COQ33543Medicare UPIN