Provider Demographics
NPI:1912559360
Name:STEWART, MARCEE (FNP)
Entity Type:Individual
Prefix:
First Name:MARCEE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8309
Mailing Address - Country:US
Mailing Address - Phone:541-816-5204
Mailing Address - Fax:
Practice Address - Street 1:3312 GATEWAY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1054
Practice Address - Country:US
Practice Address - Phone:541-204-4745
Practice Address - Fax:541-393-1038
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201905669NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1713802Medicaid