Provider Demographics
NPI:1558764399
Name:STEWART, MARISSA CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:CHRISTINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:CHRISTINE
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 S SAN SABA
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3113
Mailing Address - Country:US
Mailing Address - Phone:210-207-6592
Mailing Address - Fax:210-207-6599
Practice Address - Street 1:215 S SAN SABA
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3113
Practice Address - Country:US
Practice Address - Phone:210-207-6592
Practice Address - Fax:210-207-6599
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily