Provider Demographics
NPI:1437293719
Name:STEWART, LOUISA A (PAC)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:A
Last Name:STEWART
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 WALTER REED RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4437
Mailing Address - Country:US
Mailing Address - Phone:910-609-4000
Mailing Address - Fax:
Practice Address - Street 1:2170 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2999
Practice Address - Country:US
Practice Address - Phone:800-733-5357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102231207T00000X
NCMT0237126363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC3823BMedicare PIN
S34219Medicare UPIN