Provider Demographics
NPI:1821876400
Name:STEWART, ECHO MICHELLE
Entity Type:Individual
Prefix:
First Name:ECHO
Middle Name:MICHELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ECHO
Other - Middle Name:MICHELLE
Other - Last Name:BROCKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1441 NE 136TH AVE APT 258
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5984
Mailing Address - Country:US
Mailing Address - Phone:208-339-6289
Mailing Address - Fax:
Practice Address - Street 1:1441 NE 136TH AVE APT 258
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5984
Practice Address - Country:US
Practice Address - Phone:208-339-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR47885BC47E1B39B4246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy