Provider Demographics
NPI:1619160280
Name:STEWART, HOLLY DANIELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:DANIELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 E 4500 S STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3936
Mailing Address - Country:US
Mailing Address - Phone:801-262-9800
Mailing Address - Fax:
Practice Address - Street 1:348 E 4500 S STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3936
Practice Address - Country:US
Practice Address - Phone:801-262-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT379717-4405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health