Provider Demographics
NPI:1548405582
Name:STEWART, SALLEY ANNE (RNC,NP)
Entity Type:Individual
Prefix:
First Name:SALLEY
Middle Name:ANNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:RNC,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WILSHIRE BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2344
Mailing Address - Country:US
Mailing Address - Phone:310-837-1777
Mailing Address - Fax:
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:STE 201
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2344
Practice Address - Country:US
Practice Address - Phone:310-837-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF8435363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF8435OtherCA LICENSE